出血为首发症状的多发性骨髓瘤七例分析  

Analysis of seven cases of multiple myeloma with initial manifestation of bleeding

作　　者：赵彩芳 胡慧仙 陈丽 王丽莉 魏斌 徐晗 Zhao Caifang;Hu Huixian;Chen Li;Wang Lili;Wei Bin;Xu Han(Department of Hematology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,JinHua Municipal Central Hospital,Zhejiang,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院金华市中心医院血液科,浙江省金华市321000

出　　处：《中华内科杂志》2021年第9期831-833,共3页Chinese Journal of Internal Medicine

基　　金：金华市科学技术研究计划公益类项目(2017-4-028)。

摘　　要：回顾性分析2007年1月至2019年12月浙江大学医学院附属金华医院7例以出血及凝血异常为首发表现的多发性骨髓瘤(MM)患者临床特征、诊疗经过及误诊原因。对7例凝血异常的MM患者的临床表现、实验室及影像学检查做出详细描述和分析。治疗前凝血因子活性测定,1例为单个Ⅹ因子缺乏,2例为单个Ⅶ因子缺乏,4例为多因子缺乏。初诊时间病程2-10个月,确诊后在补充血浆及凝血因子等治疗下,予以化疗后凝血功能恢复正常时间为28-84 d。以出血及凝血异常为首发表现的MM患者出血征象明显,皮下血肿较大,部位多发,位置较深。初诊时因骨髓穿刺相对禁忌,易造成误诊误治,临床医师需提高对此类患者的认识。A retrospective analysis of 7 patients of multiple myeloma(MM)with initial manifestation of bleeding and coagulation abnormalities were performed.Clinical manifestations,laboratory and imaging examinations were collected.The activity of coagulation factors was measured before the treatment.Single factor X deficiency was seen in one patient.Two cases had factorⅦdeficiency,while four other patients had multiple factor deficiency.The time from onset of symptoms to diagnosis ranged from 2 to 10 months.After anti-MM treatment started and plasma or coagulation factors were transfused,the prolonged coagulation time returned to normal from 28-84 days.Most of these patients presented large,deep and multiple sites of hematoma,which caused concerns of bone marrow puncture and may direct to other differential diagnoses.This is helpful to improve physicians′understanding of the special clinical characteristics in MM patients.

关 键 词：凝血异常 凝血因子活性 皮下血肿 出血征象 浙江大学医学院 初诊时间 误诊误治 多发性骨髓瘤 

分 类 号：R733.3[医药卫生—肿瘤]