Bleeding Diathesis Secondary to a Heparin-Like Anticoagulant in a Patient with Multiple Myeloma—A Case Report and Review of Literature

Abstract Multiple myeloma (MM) is a clonal plasma cell disorder that commonly presents with anemia, renal failure, hypercalcemia, and lytic bone lesions. MM also frequently associated thrombotic complications; however, it may rarely present bleeding diathesis. We report case of 42-year-old gentleman relapsed immunoglobulin G lambda who presented epistaxis, gingival bleeding, oozing at the venepuncture site. Routine tests coagulation revealed prolonged prothrombin time (PT), activated partial thromboplastin (aPTT), thrombin time. The PT aPTT failed to correct pooled normal patient was thus diagnosed have an acquired heparin-like anticoagulant (HLAC). source this HLAC has long been debated, but recent data demonstrated be paraproteins produced by malignant cells. treated intravenous protamine sulfate, repeated cycles exchange, daratumumab-based quadruplet regimen eventually succumbed intracranial hemorrhage. rare potentially fatal complication must considered when patients