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Bleeding due to acquired dysfibrinogenemia as the initial presentation of multiple myeloma
  1. Namrah Siddiq1,
  2. Colin Bergstrom1,
  3. Larry D Anderson Jr2 and
  4. Srikanth Nagalla2
  1. 1 Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2 Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
  1. Correspondence to Dr Namrah Siddiq, namrahsiddiq{at}


Patients with multiple myeloma (MM) are at risk for acquired dysfibrinogenemia resulting in laboratory abnormalities and/or bleeding complications. We describe a 63-year-old man who presented with bleeding diathesis in the presence of a low fibrinogen activity level with a normal fibrinogen antigen level. Further studies revealed elevated levels of lambda free light chains, and he was diagnosed with MM. Despite initiating treatment with bortezomib/dexamethasone, he continued to have recurrent bleeds along with hypofibrinogenaemia, prompting a switch to carfilzomib/dexamethasone. The patient responded with improvement in bleeding symptoms, normalisation of fibrinogen activity and a decrease in serum free light chains.

  • chemotherapy
  • haematology (incl blood transfusion)
  • cancer intervention
  • malignant and benign haematology
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  • Contributors All authors have reviewed the final version of this manuscript. NS wrote the manuscript. CB edited the manuscript. LDA and SN provided direct clinical care to the patient and edited the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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