Acquired heparin-like anticoagulation process in a patient with multiple myeloma: a case report and literature review

A 48-year-old multiple myeloma patient with renal insufficiency developed sustained bleeding after vein puncture. Coagulation studies showed a prolonged activated partial thromboplastin time and thrombin time. Addition of an equal volume of normal plasma did not correct the activated partial thromboplastin time completely, while the prolonged thrombin time was corrected by protamine sulfate in vitro, which indicated the presence of heparin-like anticoagulants. In our case, both of the infusion of fresh-frozen plasma or dialysis had no significant effect on the coagulation studies or the bleeding time. The patient achieved complete remission after 2 cycles of chemotherapy (bortezomib combined with cyclophosphamide and dexamethasone), meanwhile the bleeding stopped and the abnormal coagulation studies were corrected, which suggest that myeloma cells may be a source of heparin-like anticoagulants. But the source of heparin-like anticoagulants is unclear. It is worth noting that the type of M protein of our patient is IgD lambda light chain and lambda light chain, which is not reported in previous literatures, and the special type of M protein may be the source of heparin-like anticoagulants in our patient. Heparin-like anticoagulants may lead to severe bleeding in multiple myeloma patients, so early evaluation of the coagulation function of multiple myeloma patients is clinically important for early intervention.