Diathesis in Multiple Myeloma

ABNORMAL bleeding has been recognized as a presenting symptom in multiple myeloma (Wintrobe, 1961) though less frequently encountered than pain, tumours, deformity, pathological fractures and neuralgic or neurological symptoms. Bernard, Inceman, Zara and Christol (1952) comment that haemorrhage is found more frequently as a secondary or terminal feature than as a presenting symptom, but concede that it is common. In their series of Ioo cases haemorrhage was present in 37, in I8 cases moderate and in I9 cases severe. Of 13 cases described by Rosenthal and Vogel (1937) hemorrhage occurred in five. While Lichtenstein and Jaffd (1947) do not include abnormal bleeding as a common presenting symptom, they refer to a purpuric tendency and call attention to a disorder of the clotting mechanism, characterized by poor clot retraction, which may occur. Osserman comments on bleeding into the gastro-intestinal tract as a feature of the disease (I959). It is the purpose of this paper to report a case of multiple myeloma in which the presenting symptoms were those of haemorrhage, together with an investigation into the nature of the abnormal bleeding.