skip to main content

Multiple Myeloma Neuraxial Risk — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardPreoperative AssessmentMultiple Myeloma Neuraxial RiskFRCA Final

A 55-year-old man (ASA III) with multiple myeloma and pathological vertebral fractures requires posterior spinal stabilisation. Which specific haematological consideration affects neuraxial anaesthesia?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Only general anaesthesia is possible in myeloma

Multiple myeloma affects coagulation through multiple mechanisms: (1) thrombocytopenia from bone marrow infiltration, (2) paraprotein coating of platelets causing acquired platelet dysfunction, (3) paraprotein interference with fibrin polymerisation, (4) acquired factor X deficiency (in AL amyloidosis), and (5) hyperviscosity syndrome. Standard coagulation tests may not reflect the true bleeding risk. Platelet count AND function, plus coagulation screen, should be assessed before neuraxial blockade. Involvement of the haematology team is essential. Additionally, vertebral destruction from myeloma may make neuraxial technique technically difficult.

Reference: BSH – 2021 – Myeloma guidelines; RCOA – 2023 – Haematological disorders and regional anaesthesia