April 1983

Increased Fibrinolysis and Amyloidosis

Author Affiliations

From the Division of Hematology, the Department of Medicine, the University of Southern California School of Medicine and the Los Angeles County-University of Southern California Medical Center.

Arch Intern Med. 1983;143(4):678-682. doi:10.1001/archinte.1983.00350040068009

• We studied three patients with amyloidosis who had a significant hemorrhagic disorder secondary to increased fibrinolysis. In two of the three patients, bleeding was one of the major initial problems; in the other patient, bleeding occurred later in the course of the disease. All three patients were men with primary or myeloma-associated amyloidosis (ie, immunoglobulin-related or AL). None of the patients had significantly impaired liver function at the time of the diagnosis of increased fibrinolysis. At admission, fibrinogen levels were 60,170, and 90 mg/dL in the three patients. All three patients had short euglobulin clot lysis times (<30 minutes) and evidence of in vitro clot lysis. One patient appeared to respond to aminocaproic acid (EACA). In patients with amyloidosis and bleeding, fibrinolytic tests should be done; in patients with increased fibrinolysis, a diagnosis of amyloidosis should be considered.

(Arch Intern Med 1983;143:678-682)