Bleeding symptoms and coagulation abnormalities in 337 patients with AL‐amyloidosis

• DOI: 10.1046/j.1365-2141.2000.02183.x
• Publication Date: 2003-03-11T06:27:06Z
• Authors: Andrew D. Mumford; James O'donnell; Julian D. Gillmore; Richard A. Manning; Philip N. Hawkins; Michael Laffan
• Keywords: AL amyloidosis; Prothrombin time

Haemorrhage is a frequent manifestation of amyloidosis. We performed retrospective clinical analysis 337 patients with systemic immunoglobulin light-chain (AL)-amyloidosis, in whom whole-body serum amyloid P component (SAP) scintigraphy and clotting screen had been performed. Abnormal bleeding was noted 94 cases (28%), the coagulation abnormal 172 (51%). The most common abnormalities were prolongation thrombin time (TT; 108 cases, 32%) prothrombin (PT; 82 24%). In multivariate analysis, prolonged PT only abnormality associated (P = 0.0012), but this independent load. Prolongation TT hepatic infiltration < 0.00001), proteinuria 0.001) low albumin 0.00001). 154 who studied further, subnormal factor X activity (FX:C) found 22 (14%). FX:C, corresponding antigen (FX:Ag) measurements consistently higher (median FX:Ag/FX:C 2.5, range 0.81-9.25, n 16) than normal FX:C 0.96, 0.65-1.29, 28, 0.0001). No evidence an FX inhibitor. Of 48/154 (31%) TT, reptilase also 38/48 (79%). These data show that haemorrhage are AL-amyloidosis multifactorial origin. provide suggesting nephrotic syndrome determinants TT. patients, explained by reduction not wholly FX:Ag.