Myeloma Presenting with Pancytopenia: Our Experience from a Tertiary Care Center in South India

BACKGROUND AND OBJECTIVES: Multiple myeloma commonly presents with anemia, but it is uncommon for patients to exhibit pancytopenia at initial presentation. Early diagnosis depends on correlating clinical symptoms with radiological and pathological evidence. The objective of this study is to assess these parameters in myeloma cases presenting with pancytopenia. MATERIALS AND METHODS: This retrospective study was carried out at our institution over a 20-month period, involving patients diagnosed with multiple myeloma, including those who initially presented with pancytopenia. Information regarding demographics, laboratory investigations, and bone marrow results was sourced from the laboratory information system, whereas clinical and radiologic details were retrieved from medical records. RESULTS: Among the 47 cases of multiple myeloma selected for this study, 10 presented with pancytopenia. The most frequently reported symptom was lower back pain. Their mean serum calcium and creatinine levels were lower than the nonpancytopenic cases. Hypercalcemia and renal dysfunction were noted in 35% and 54% of the nonpancytopenic cases, respectively. Radiologic imaging identified lytic lesions involving both the axial and appendicular skeleton in both the groups. Bone marrow plasma cell infiltration was higher in cases with pancytopenia (56.4%) as compared to those without pancytopenia (35.3%). Anemia and thrombocytopenia were also noted in 97% and 38% of the nonpancytopenic cases, respectively. CONCLUSION: Pancytopenia can exacerbate the clinical course of multiple myeloma by increasing susceptibility to infections and causing manifestations related to thrombocytopenia. Prompt diagnosis in such cases demands a high index of suspicion along with integrated clinical, pathological, and radiological assessment.