Correlation of prothrombin time and activated partial thromboplastin time with serum immunoglobulins in newly diagnosed patients with plasma cell dyscrasias: an experience from tertiary care centre
DOI:
https://doi.org/10.18203/2349-3933.ijam20181081Keywords:
aPTT, PT, Multiple myelomaAbstract
Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCD
Methods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.
Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).
Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.
References
Zangari M, Elice F, Fink L, Tricot G. Hemostatic dysfunction in paraproteinemias. Seminars in Thrombosis and Hemostasis. 2007;33:339-49.
Robert F, Mignucci M, McCurcy SA, Maldonado N, Lee JY. Hemostatic abnormalities associated with monoclonal gammopathies. Am J Med Sci. 1993;306:359-66.
Perkins H, Mackenzie MR, Fudenberg HH. Hemostatic defects in dysproteinemias. Blood. 1970;35:695-707.
Glaspy JA. Hemostatic abnormalities in multiple myeloma and related disorders. Hematol Oncol Clin North Am. 1992;6:1301-14.
Colwell NS, Tollefsen DM, Blinder MA. Identification of a monoclonal thrombin inhibitor associated with multiple myeloma and a severe bleeding disorder. Br J Haematol. 1997;97:219-26.
Carr ME Jr, Dent RM, Carr SL. Abnormal fibrin structure and inhibition of fibrinolysis in patients with multiple myeloma. J Lab Clin Med. 1996;128:83-8.
Lackner H. Hemostatic abnormalities associated with dysproteinemias. Semin Hematol. 1973;10:125-33.
Bick RL. Alterations of hemostasis associated with malignancy: etiology, pathophysiology, diagnosis and management. Semin Thromb Hemost. 1978;5:1-26.
Nilehn JE, Nilsson IM. Coagulation studies in different types of myeloma. Acta Med Scand Suppl. 1966;445:194-9.
Dispenzieri A, Lacy MQ, Greipp PR. Multiple myeloma. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, eds. Wintrobe’s clinical hematology. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:2584-2636.
Saif MW, Allegra CJ, Greenberg B. Bleeding diathesis in multiple myeloma. J Hematother Stem Cell Res. 2001;10:657-60.
Teng HW, Chen PM, Yang YH, Gau JP. The prolonged activated partial thromboplastin time at diagnosis indicates less favorable prognosis in IgA myeloma. Japanese J Clin Oncol. 2007;37:609-14.
Pandey S, Post SR, Alapat DV, Smock KJ, Post GR. Prolonged prothrombin time correlates with serum monoclonal protein concentration in patients with plasma cell dyscrasia. Int J Lab Hematol. 2013;35:421-7.
Huang H, Li H, Li D. Effect of serum monoclonal protein concentration on haemostasis in patients with multiple myeloma. Blood Coagul Fibrinolysis. 2015;26(5):555-9.