Can you Diagnose Immune Thrombocytopenia in Myeloma? A Case of Thrombocytopenia in a Patient with Multiple Myeloma

Multiple myeloma (MM) is the second most common haematological malignancy, the diagnosis of which has doubled in recent years. Immune thrombocytopenia consists of isolated thrombocytopenia secondary to antibody mediated peripheral platelet destruction. In most cases, there is no identifiable cause (primary immune thrombocytopenia). Its association with multiple myeloma is rare. Early recognition of this association is essential for raising awareness among clinicians, allowing for a rapid differential diagnosis and therapeutic optimization, reducing side effects and improving prognosis. Thus, we present a clinical case of concomitant immune thrombocytopenia and MM, whose initial presentation was thrombocytopenia. This clinical case is the first case among thirteen described in the literature in which chemotherapy was the initial treatment for both pathologies, as seen in this review.

Learning points: Multiple myeloma is the second most common haematological malignancy and is associated with a broad group of pathologies, including, in some cases, autoimmune manifestations. Thrombocytopenia in multiple myeloma is common due to therapy or bone marrow plasmacytosis, but the association of immune thrombocytopenia with multiple myeloma is rare.Raising clinicians' awareness of the association of multiple myeloma with immune thrombocytopenia is essential for a rapid differential diagnosis. This can alter therapeutic possibilities and consequent patient prognoses.