Multiple myeloma with hepatosplenomegaly.

1Assistant Professor, Internal Medicine; 2Assistant Professor, Pathology; 3Head of Department of Critical Care; Military Hospital, Trivandrum Received: 22.07.2011; Accepted: 10.08.2013 Sir, T e C a s e r e p o r t “ M u l t i p l e m y e l o m a p r e s e n t i n g w i t h hepatosplenomagaly”1 was interesting and we would l ike to o f fer these comments 1. Peripheral blood smear giving a clue to plasma cell dyscrasia in a case of hepatosplenomegaly amyloidosis and secondary myelofibrosis need to be excluded.No bone marrow finding pertaining to exclusion of myelofibrosis and congo red staining/ IHC relating to amyloidosis has been made in this case. 2. Plasma ce l l l eukaemia require more aggressive chemotherapy in form of Bortezomib based therapy from beginning. Thalidomide based chemotherapy has no role. 3. The major side effect of DVT occurs when tumour load is high and tha l idomide i s combined wi th chemotherapy. Accordingly in this setting anticoagulant prophylaxis with LMWH or aspirin is mandatory.2 4. Anaemia treatment part in this case has not addressed (e i ther in terms of recombinant human EPO, i ron supplements , b lood t ransfus ion , GCSF) ne i ther i t s response to treatment (Thalidomide/ Bortezomib). Aggressive correction o f a n a e m i a c a n p r e d i s p o s e t o thrombotic events.