Sabobeh Taher, Brugioni Emily K, Masoud Amgad, Madhusudhana Sheshadri, Mateescu Valerica
Internal Medicine, University of Missouri Kansas City, Kansas City, USA.
Hematology and Oncology, University of Missouri Kansas City, Kansas City, USA.
Cureus. 2021 Feb 11;13(2):e13293. doi: 10.7759/cureus.13293.
Multiple myeloma is a plasma cell neoplasm characterized by clonal proliferation of immunoglobulin producing terminally differentiated B cells. Classically patients are described to present with bone pain, hypercalcemia, anemia, and/or renal impairment. A less described clinical manifestation related to the myeloma is acquired coagulation abnormalities including paraprotein interfering with the coagulation cascade or exhibiting specific antibody activity. Factor X deficiency is reported in patients with secondary amyloidosis. We describe a patient who presented with bleeding tendency and an abnormal prothrombin and activated partial thromboplastin times (PT/PTT) due to factor X deficiency. A thorough workup revealed the diagnosis of multiple myeloma with the presence of monoclonal lambda light chain restricted plasma cells with qualifying end-organ damage without evidence of amyloidosis. Prior to the ultimate diagnosis, the patient succumbed to septic shock and acute respiratory distress syndrome due to infection.
多发性骨髓瘤是一种浆细胞肿瘤，其特征为产生免疫球蛋白的终末分化B细胞的克隆性增殖。传统上，患者表现为骨痛、高钙血症、贫血和/或肾功能损害。与骨髓瘤相关的一种较少描述的临床表现是获得性凝血异常，包括副蛋白干扰凝血级联反应或表现出特定抗体活性。继发性淀粉样变性患者中报告有因子X缺乏。我们描述了一名因因子X缺乏而出现出血倾向以及凝血酶原和活化部分凝血活酶时间（PT/PTT）异常的患者。全面检查显示诊断为多发性骨髓瘤，存在单克隆λ轻链受限的浆细胞，并伴有符合条件的终末器官损害，且无淀粉样变性证据。在最终诊断之前，患者因感染死于感染性休克和急性呼吸窘迫综合征。
