Clinical Case Database / Category: Patient Management
Multiple myeloma complicated by thrombosis
Dr Gerardo Errico, Dr Nick Morley
Foundation Years Journal, volume 9, issue 3, p.16 (123Doc Education, London, March 2015)
Multiple Myeloma is a malignancy characterised by clonal expansion of plasma cells in the bone marrow and usually the subsequent over expression of a monoclonal immunoglobulin (M-protein) in the blood. It accounts for 1% of all malignancies and 15% of haematological malicnancies (1). The median age at diagnosis is approximately 70 years of age therefore it can be considered disease of the elderly. Myeloma is heterogeneous in its presentation, from complications due to lytic lesions and hypercalcaemia to anaemia and renal failure. Investigation of myeloma is relatively straight forward; however interpretation of immunoglobulin results as they come back is poorly understood and often proves problematic.
Although Myeloma is a largely incurable cancer, with modern therapeutics the prognosis has improved significantly in the last 15 years. A typical patient with Myeloma will have multiple remissions and relapses with a new treatment for each relapses. Here I recount a case of myeloma in a typical patient; from diagnosis to current status in her disease. Discussion includes interpretation of immunoglobulin results and the initial investigations in myeloma. Her case is unusual in that she developed a thrombosis in an unusual site as a result of her treatment. The complication has an ongoing impact in her management and overall prognosis.
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Dr Gerardo Errico
Haematology Specialist Registrar
Royal Hallamshire Hospital
Sheffield, S10 2JF
Dr Nick Morley (Corresponding author)
Royal Hallamshire Hospital
Sheffield, S10 2JF
1. Antonio Palumbo, M.D., and Kenneth Anderson, M.D. Review Article. Medical Progress Multiple Myeloma. N Engl J Med 2011;364:1046-60.
2. Birgegård G, Gascón P, Ludwig H.Evaluation of anaemia in patients with multiple myeloma and lymphoma: findings of the European Cancer Anaemia Survey. Eur J Haematol 2006;77:378-86.
3. Jenny M Bird et al. Guidelines for the management of Multiple Myeloma. British Committee for Standards in Haematology.
4. Blom JW, Doggen CJ, Osanto S, Rosendaal FR.Malignancy, prothrombotic mutations and the risk of venous thrombosis. JAMA 2005;293(6):715-722.
5. Musallam KM, Dahdaleh FS, Shamseddine AI, Taher AT. Incidence and prophylaxis of venous thromboembolic events in multiple myeloma patients receiving immunomodulatory therapy. Thromb Res 2009;123(5):679-686.
6. Iman A. Abdalla, MD, and Imad A. Tabbara, MD. Nonsecretory Multiple Myeloma. South Med J. 2002;95(7).
7. Zacharski LR, Prandoni P, Monreal M. Warfarin versus low-molecular weight heparin therapy in cancer patients. Oncologist.2005 Jan;10(1):72-9.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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