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Howard Liebman, MD; Mark Chinowsky, MD; John Valdin, MD; Gayle Kenoyer; Donald Feinstein, MD

Arch Intern Med. 1983;143(4):678-682.

Abstract
• 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)

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.

Footnotes
Accepted for publication Nov 8, 1982.

Reprint requests to Hematology Division, University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Feinstein).

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