Clinical Case Database / Category: Patient Management

Multiple myeloma complicated by thrombosis

Publication details

Dr Gerardo Errico, Dr Nick Morley
Foundation Years Journal, volume 9, issue 3, p.16 (123Doc Education, London, March 2015)

Abstract

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.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Authors

Dr Gerardo Errico

Haematology Specialist Registrar
Haematology Department
Royal Hallamshire Hospital
Glossop Road
Sheffield, S10 2JF
gerardo.errico@sth.nhs.uk

Dr Nick Morley (Corresponding author)

Consultant Haematologist
Haematology Department
Royal Hallamshire Hospital
Glossop Road
Sheffield, S10 2JF
nick.morley@sth.nhs.uk

References

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.

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he 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.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.