[Severe Hemostatic Dysfunction during Multiple Spinal Fusion Surgery in a Patient with Multiple Myeloma].

We report a patient with multiple myeloma who developed severe hemostatic dysfunction during spinal fusion surgery. A 74-year-old man presented with lower limb paralysis due to thoracic supine pathological fracture and was scheduled for spinal fusion surgery. He suffered from multiple myeloma for decades but did not present with any significant abnormalities in a preoperative blood exam. Prothrombin time international normalized ratio (PT-INR, 0.97) and activated partial thromboplastin time (APTT, 31 sec) were normal. Surgeons confronted hemostatic difficulty during surgery. At the point of 1,000 ml blood loss, PT-INR was 9.99, APTT was 300 sec, and platelet count was 116,000 x μl(-1). The patient was administered 1,400 ml of frozen plasma concentrate; PT-INR and APTT recovered to 1.04 and 39.6 sec, respectively. Hemostatic dysfunction in this patient may have resulted from an inherent coagulation deficiency associated with multiple myeloma.