Multiple myeloma with coagulopathy suspected of being due to paraprotein with lupus anticoagulants activity

Abstract

We describe the case of a 70-year-old Japanese woman with multiple myeloma with coagulopathy that was suspected of being due to paraprotein with lupus anticoagulants activity. A close examination of the cause of the prolonged aPTT revealed a positive for all endogenous inhibitors and the presence of LAs were suspected, including the results of the mixing test. Partial response was achieved with multiple chemotherapy regimens, but the coagulation abnormalities did not improve. However, EPd therapy reached a deeper response (normalized the FLC ratio and the achievement of deep minimal residual disease level) , and simultaneously, aPTT normalized and inhibitor disappeared. This suggests that a small amount of paraprotein has LA activity. The patient was successfully treated with rivaroxaban for thromboprophylaxis, without thrombotic or bleeding events. Therefore, in patients with multiple myeloma who have a prolonged aPTT, it is important to suspect the presence of LAs, perform a mixing test, and take appropriate prevention against thrombosis, which may lead to improved outcomes.