Department of Hematology, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu, Aichi, 474-8511, Japan.
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Hematol. 2024 Dec;120(6):743-749. doi: 10.1007/s12185-024-03849-2. Epub 2024 Sep 18.
Approximately 7% of patients with newly diagnosed multiple myeloma (MM) experience bleeding complications with varying causes, but few reports have described these complications. Here we report the case of a patient with newly diagnosed MM who presented with a bleeding tendency and various coagulation abnormalities. Chromogenic assays, thrombin time, and reptilase time revealed the presence of a thrombin-inhibiting substance that inhibited release of fibrinopeptide A from fibrinogen. The coagulation abnormalities improved after treatment with daratumumab, lenalidomide, and dexamethasone. As the thrombin inhibition mechanism remains unclear, no previous studies have reported recent treatment outcomes in older patients producing thrombin-inhibiting substances, which can hinder clinical treatment. Therefore, we believe that the diagnosis and the treatment course of this case provide valuable information. Moreover, such case reports provide significant insights into the pathophysiology of bleeding complications associated with MM.
约 7%的新诊断多发性骨髓瘤 (MM) 患者会出现不同病因的出血并发症，但很少有报道描述这些并发症。在这里，我们报告了一例新诊断 MM 患者，其表现为出血倾向和多种凝血异常。显色测定、凝血酶时间和蝰蛇毒时间显示存在一种抑制凝血酶从纤维蛋白原释放纤维肽 A 的物质。用达雷妥尤单抗、来那度胺和地塞米松治疗后，凝血异常得到改善。由于凝血酶抑制机制尚不清楚，以前的研究没有报告过产生抑制凝血酶物质的老年患者的最新治疗结果，这可能会阻碍临床治疗。因此，我们认为该病例的诊断和治疗过程提供了有价值的信息。此外，此类病例报告为 MM 相关出血并发症的病理生理学提供了重要见解。
