Paraprotein-related Bleeding as a First Symptom of Multiple Myeloma

Specific affinity characteristics of the neoplastic paraprotein have been established as exceptional causes of bleeding in patients with malignant gammopathies. We describe a case in which a relationship between impaired coagulation parameters and the concentration of serum paraprotein, without specific affinity for any coagulation protein, could be established. Alternative causes of bleeding were discarded and a correlation between serum monoclonal paraprotein concentration and activated partial thromboplastin time was established. Multiple myeloma treatments achieved minor responses only, but were otherwise associated with partial improvement in coagulation parameters and, most importantly, control of the bleeding episodes. The interference in the coagulation process appeared to be non-specific and related to paraprotein concentration only but was not related to hyperviscosity. The case emphasizes the need to suspect of atypical effects of paraproteinemia in patients with monoclonal gammopathy of unknown significance and eventually to treat the underlying plasma cell dyscrasia if symptoms, like severe bleeding, justify that intervention.