COAGULATION DISORDER IN MULTIPLE MYELOMA

• Pathological Basis:
  Hemorrhagic abnormalities associated with multiple myeloma are frequently multifactorial in origin:
  • Hyperviscosity syndrome: causing mucous membrane bleeding, severe headache.
  • Qualitative and quantitative abnormalities of platelets.
  • Nonspecific inhibitors causing elevated PT, APTT, TT.
  • Specific inhibitors of factor VIII.
  • Chronic DIC: 50% of patients with multiple myeloma have elevated FSP.
• Treatment:
  • Plasmapheresis for immediate relief of bleeding. Between 6 to 8 liters of plasmamy removed during the first 2 to 4 days.
  • Manage underlying malignant process with chemotherapy.