Increased fibrinolysis and amyloidosis

Area of Science:

• Hematology
• Oncology

Background:

• Amyloidosis, particularly immunoglobulin-related (AL) amyloidosis, can manifest with diverse clinical symptoms.
• Hemorrhagic disorders are a less common but significant complication in some amyloidosis patients.

Observation:

• This study examined three male patients with primary or myeloma-associated amyloidosis presenting with significant bleeding.
• Bleeding was a primary issue in two patients and occurred later in one, all without significant liver dysfunction.
• Laboratory findings included low fibrinogen levels and shortened euglobulin clot lysis times, indicating hyperfibrinolysis.

Findings:

• All three patients exhibited evidence of increased systemic fibrinolysis, a key factor in their hemorrhagic diathesis.
• One patient showed a positive response to aminocaproic acid (EACA), an antifibrinolytic agent.
• The study highlights a strong association between amyloidosis and secondary hyperfibrinolysis.

Implications:

• Routine fibrinolytic screening is recommended for patients with amyloidosis and bleeding symptoms.
• Increased fibrinolysis warrants consideration of amyloidosis as a potential underlying diagnosis.
• Early identification and management of hyperfibrinolysis can mitigate bleeding risks in amyloidosis.