Willner Christopher A, Chisti Mohammed M
Department of Internal Medicine, Beaumont Royal Oak, Royal Oak, MI, USA.
Department of Hematology and Oncology, Beaumont Royal Oak, Royal Oak, MI, USA.
Case Rep Hematol. 2018 Jun 13;2018:4342301. doi: 10.1155/2018/4342301. eCollection 2018.
The development of a heparin-like anticoagulant (HLAC) in plasma cell neoplasia has previously been described in clinical literature. Testing of this HLAC, primarily in vitro, has demonstrated that neutralization may be achieved with protamine sulfate, owing to antithrombin III cofactor activity. We report a case in which intravenous protamine sulfate was administered to a patient with IgG-kappa monotypic multiple myeloma, which resulted in resolution of bleeding and coagulopathy, confirmed via objective laboratory data. Our case is intended to demonstrate that intravenous protamine sulfate should be considered in acute bleeding with plasma cell neoplasia. We review the literature to observe past experiences about this phenomenon. We postulate that chemotherapy, targeted therapies, and immunotherapies may also disrupt production of a HLAC. With further investigation, this strategy could be applicable in other hematological malignancies with bleeding diathesis, chiefly if the pathophysiology of the HLAC is precisely defined.
血浆细胞瘤中类肝素抗凝剂（HLAC）的发展此前已在临床文献中有所描述。对这种HLAC的检测主要在体外进行，结果表明由于抗凝血酶III辅因子活性，硫酸鱼精蛋白可实现中和作用。我们报告了一例向IgG-κ单型多发性骨髓瘤患者静脉注射硫酸鱼精蛋白的病例，通过客观实验室数据证实，这使得出血和凝血病得到缓解。我们的病例旨在表明，对于血浆细胞瘤急性出血，应考虑静脉注射硫酸鱼精蛋白。我们回顾文献以观察关于这一现象的既往经验。我们推测化疗、靶向治疗和免疫治疗也可能干扰HLAC的产生。随着进一步研究，这一策略可能适用于其他有出血倾向的血液系统恶性肿瘤，主要是如果HLAC的病理生理学能被精确界定的话。
