以冷凝集素综合征为首发表现的多发性骨髓瘤患者的早期诊断

Early Diagnosis of One Multiple Myeloma Patient with Cold Agglutinin Syndrome as the Initial Presentation

目的:分析1例以冷凝集素综合征(CAS)为首发表现起病的多发性骨髓瘤(MM)患者的临床资料,以提高对该病的认识和临床筛查。方法:对患者一般资料、实验室检查及骨髓结果、治疗方案做阐述和总结,为MM继发CAS的早期诊治提供思路。结果:患者出现乏力、血尿、黄疸、全身网状青斑等临床表现为MM继发CAS所致,与一般的雷诺现象不同,根据骨髓象及免疫固定电泳等明确诊断为Ig Mκ型MM,给予BAD方案化疗3个疗程,并加强保暖支持治疗后,贫血纠正,M蛋白减低,冷凝集现象明显减轻,疗效评估达非常好的部分缓解。结论:以CAS为首发表现的MM极为罕见,临床易漏诊。因此早期确诊及个体化治疗显得格外重要,需要临床医生进一步观察总结经验。

Objective:To analyze one case of multiple myeloma(MM) initially presenting cold agglutinin syndrome(CAS),so as to improve clinical understanding and screening of this disease.Methods:The clinical data,laboratory examination,bone marrow result,diagnosis and treatment of the patient were analyzed and summarized to provide ideas and clinical experience for the early diagnosis and treatment of CAS secondary to MM.Results:The clinical manifestations of asthenia,hemolysis,jaundice and scattered livedo reticularis were caused by CAS secondary to MM,which was different from the general Raynaud’s phenomenon.IgMκ type MM was definitely diagnosed according to the morphological features of bone marrow cells and immunofixation electrophoresis.After 3 courses of chemotherapy with BAD regimen and enhanced thermal support,anemia was corrected,M protein was decreased and the cold agglutinin phenomenon was significantly reduced.The evaluation of efficacy reached very good partial response.Conclusion:There are very few MM patients with CAS as the initial presentation,so it is easy to misdiagnose.Early diagnosis and individual therapy are particularly important,which requires clinicians to observe and gain experience further.