Coexisting Thalassemia, Immune Thrombocytopenic Purpura, and Multiple Myeloma With Osteopenia: Complex Hematologic Case in an Adult Asian Male Patient

Abstract

We report a rare case of a 45-year-old Asian male patient with concurrent multiple myeloma (MM), immune thrombocytopenic purpura (ITP), and thalassemia trait, presenting with severe thrombocytopenia, back pain, and bleeding manifestations. The diagnosis was established through a combination of laboratory findings, imaging, and bone marrow biopsy, revealing 90% plasma cell involvement and KRAS/BRCA2 mutations. Management focused on controlling ITP with corticosteroids, rituximab, and platelet transfusions while addressing immunosuppression risks. Due to logistical limitations, MM-specific therapy was deferred, and the patient was stabilized for transfer to continue treatment in his home country. This case highlights the challenges of managing overlapping hematologic disorders and underscores the importance of individualized care in complex presentations.

Keywords: corticosteroid therapy; diagnosis of multiple myeloma; immune thrombocytopenia purpura; non-transfusion-dependent thalassemia; rituximab.

Figure 1. Findings suggestive of metastatic disease involving the thoracic spine with the largest lesion being in the T10 vertebral body. Pathologic compression fractures T7 and T10 (yellow arrows).

Figure 2. Peripheral blood smear: Rouleaux formation (red arrow) and target cells (yellow arrows).

Figure 3. Plasma cell neoplasm involving 90% of bone marrow cellularity.