Multiple Myeloma Coverage from Every Angle

Acquired Factor X Deficiency and Multiple Myeloma: Case Report

By: Cordi Craig, MS
Posted: Wednesday, June 2, 2021

Patients with multiple myeloma generally present with bone pain, hypercalcemia, anemia, or renal impairment. Though less common, some patients also acquire coagulation abnormalities such as paraprotein interfering with the coagulation cascade or exhibiting specific antibody activity. Valerica Mateescu, MD, of the University of Missouri Kansas City, and colleagues published a case report in the journal Cureus about a patient who presented with factor X deficiency, causing bleeding tendency, prolonged prothrombin, and activated thromboplastin times.

“Even though factor X deficiency associated with multiple myeloma is a rare entity, it must be kept in mind evaluating a patient with bleeding tendency and abnormal prothrombin and activated partial thromboplastin time,” the researchers stated. “Swift and efficient assessment must be carried to prevent bleeding complications.”

A 62-year-old woman presented with abdominal pain, nausea, vomiting, and recurrent epistaxis. The patient had a medical history of hypertension and tobacco abuse with chronic obstructive pulmonary disease but no use of illicit drugs. The patient reported forceful vomiting on the day of admission, which caused a subconjunctival hemorrhage in the left eye and epistaxis.

The researchers conducted laboratory tests and excluded other more common causes of the patient’s exhibited symptoms. After being discharged initially, the patient was readmitted the next day and quickly deteriorated overnight with hypoxic respiratory failure and symptomatic hypotension. The patient was transferred to the medical intensive care unit and suffered multiorgan failure, ultimately dying of septic shock and acute respiratory distress syndrome from Streptococcus pneumonia infection. The multiple myeloma diagnosis occurred after the patient had died, and the bone marrow report exhibited 30% to 40% plasma cell neoplasm. 

“It is important to remember multiple myeloma can be asymptomatic or present with other clinical manifestations including infections, neurologic symptoms, hyperviscosity, coagulopathy, and extramedullary disease,” the authors concluded.

Disclosure: For full disclosures of the study authors, visit

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