Abnormal serum bone Gla protein levels in multiple myeloma: crucial role of bone formation and prognostic implications

Article Abstract:

Multiple myeloma is a cancer of antibody-producing cells in the bone marrow. This cancer is frequently accompanied by excessive resorption of bone in the vicinity of the cancerous cells and a resulting hypercalcemia, or excess level of calcium in the blood. To appreciate more fully the processes that are going on within the bone in response to multiple myeloma, levels of Gla protein were measured. Gla, also called osteocalcin and serum BGP, is synthesized only in osteoblasts, the bone-forming cells. Serum BGP was measured in a number of patients, including a series of 117 patients with multiple myeloma. Gla protein levels were abnormal in 25 cases, or 21 percent. In 14 patients, the Gla levels were increased, and reflected more indolent disease in the patient, whereas in 11 patients decreased levels correlated with lytic bone lesions, hypercalcemia, and a poorer prognosis. Since Gla protein is thought to be an indicator of bone formation and to be independent of bone resorption, these results indicate that bone formation by the osteoblasts is an important factor in multiple myeloma. That is, a major difference among multiple myeloma patients may not be the rate at which bone is resorbed; rather, although bone is being resorbed in all multiple myeloma patients, some can continue to rebuild bone as it is torn away. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Bone diseases, Osteoblasts, Multiple myeloma

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The effect of desmopressin on massive gastrointestinal bleeding in hereditary telangiectasia unresponsive to treatment with cryoprecipitate

Article Abstract:

A case report is described of a patient with hereditary hemorrhagic telangiectasia, characterized by a spot on the skin formed by a dilated capillary or artery and reduced levels of von Willebrand factor (factor VIII) in the blood. The patient experienced severe recurrent bleeding from the gastrointestinal tract. Treatment with cryoprecipitate or desmopressin normalized bleeding time and partial thromboplastin time (an index of coagulability). Hematochezia, the passage of bloody stools, occurred following treatment with cryoprecipitate but not desmopressin. No further bleeding occurred following desmopressin therapy and a total colectomy (removal of the colon). Desmopressin administered intravenously is effective in the management of bleeding in patients with hereditary hemorrhagic telangiectasia, with or without von Willebrand factor deficiency. The reason that the patient responded well to desmopressin but not cryoprecipitate is unclear. Previous evidence indicates that desmopressin has direct and local effects on the blood vessel walls and results in a local increase in the adhesion of platelets, cells involved in clotting. Desmopressin administered preoperatively brought about cessation of bleeding and the surgical procedure was performed without excessive operative or postoperative bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Case studies, Telangiectasia, Hereditary Hemorrhagic, Hereditary hemorrhagic telangiectasia, Desmopressin

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