Reversal of life-threatening bleeding with protamine sulfate in a patient with plasma cell leukemia.
Journal
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
ISSN: 1473-5733
Titre abrégé: Blood Coagul Fibrinolysis
Pays: England
ID NLM: 9102551
Informations de publication
Date de publication:
01 Oct 2022
01 Oct 2022
Historique:
pubmed:
11
8
2022
medline:
19
10
2022
entrez:
10
8
2022
Statut:
ppublish
Résumé
Plasma cell disorders, such as multiple myeloma, can cause numerous derangements of hemostasis. In this case report, we present a life-threatening coagulopathy in a patient with progressing multiple myeloma in which the antibody-producing heparin-like activity is a free light chain. The patient's bleeding was successfully treated using protamine sulfate, which then allowed treatment of her plasma cell leukemia. In the literature, other authors have reported similar patients who have responded to protamine sulphate either in vitro or in vivo , providing further evidence for the role of protamine sulfate in the reversal of coagulopathy and resolution of bleeding diathesis. Standard treatments of transfusion with fresh frozen plasma and cryoprecipitate are likely to be ineffective in life-threatening bleeding related to this mechanism (heparin-like effect), and it is essential that treating physicians are aware of this potential mechanism of bleeding in their patients.
Identifiants
pubmed: 35946464
doi: 10.1097/MBC.0000000000001160
pii: 00001721-202210000-00010
doi:
Substances chimiques
Protamines
0
Heparin
9005-49-6
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
425-428Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Torjemane L, Guermazi S, Ladeb S, Ben Romdhane N, Lakhal A, Abdelkefi A, et al. Heparin-like anticoagulant associated with multiple myeloma and neutralized with protamine sulfate. Blood Coagul Fibrinolysis 2007; 18:279–281.
Hinterleitner C, Pecher AC, Kreißelmeier KP, Budde U, Kanz L, Kopp HG, Jaschonek K. Disease progression and defects in primary hemostasis as major cause of bleeding in multiple myeloma. Eur J Haematol 2020; 104:26–35.
Eby CS. Bleeding and thrombosis risks in plasma cell dyscrasias. Hematology Am Soc Hematol Educ Program 2007; 2007:158–164.
Martínez-Martínez I, González-Porras JR, José Cebeira M, de Arriba F, Espín E, Bohdan N, et al. Identification of a new potential mechanism responsible for severe bleeding in myeloma: immunoglobulins bind the heparin binding domain of antithrombin activating this endogenous anticoagulant. Haematologica 2016; 101:e423–e426.
Willner CA, Chisti MM. Treatment of bleeding diathesis associated with a heparin-like anticoagulant in plasma cell neoplasia using protamine. Case Rep Hematol 2018; 2018:4342301.
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