11) Bleeding, petechiae and bruises
Our hemostatic mechanisms are those which protect us against excessive bleeding and they include: blood vessels that contract when they are injured to limit blood loss, platelets which aggregate and plug the defect and the coagulation which forms the blood clot. Platelets originate from their mother cells “megakaryocytes” in the bone marrow. Due to the rapid growth of multiple myeloma, those mother cells are decreased in number and consequently, platelet number falls. In some other cases, coagulation factors can be affected due to their destruction by the deformed antibodies produced by plasma cells of multiple myeloma. This disorder can manifest by bleeding from surfaces including the skin in the form of small red dots called purpura or large bruises in response to minor or no trauma at all. Bleeding can also occur from the lips, gums and vagina. It can also appear in urine or feces. If platelet count falls too low, bleeding can occur within the cranial cavity and into the brain. This becomes life threatening and has to be managed rapidly and meticulously.