Gastrointestinal bleeding secondary to acquired factor x deficiency in the setting of multiple myeloma
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Abstract
A 59 year-old male with no prior history of coagulopathy presented to the hospital with recurrent gastrointestinal bleeding. Diagnostic studies revealed creatinine of 3.13 g/dL, hemoglobin of 6 g/dL, platelets of 106,000/microliter and INR of 3.3, with bleeding gastric and duodenal ulcers on endoscopy. Blending considers distinguished coagulation factor inadequacy, low direct factor X and factor X action<2%. Serum protein electrophoresis showed no monoclonal protein, but serum kappa/lambda free light chain ratio was elevated at 174.78. Bone marrow biopsy demonstrated 20-50% atypical plasma cells and absent high risk cytogenetics by FISH. Diagnosis turned into made as level III a couple of myeloma with acquired issue X deficiency. Treatment worried bortezomib, dexamethasone and component X infusions, accompanied by means of melphalan autologous stem cell transplant. By day 40 posttransplant, patient accomplished independence from issue X infusions. Bleeding happens in up to 15% of patients with a couple of myeloma, however is rarely the presenting symptom. Factor X deficiency, defined by using Factor X activity.
