title: Differential diagnosis of localized and systemic amyloidosis based on coagulation and fibrinolysis parameters.
abstract: BACKGROUND
  A simple assay that can discriminate between localized and systemic amyloidosis is needed.
  
  
  METHODS
  Coagulation and fibrinolysis parameters were measured in subjects with active or progressive systemic amyloidosis (Group A; 9 patients), systemic amyloidosis in complete remission (Group B; 6 patients), localized AL amyloidosis (Group C; 6 patients), monoclonal gammopathy of undetermined significance (Group D; 5 patients), chronic glomerulonephritis with proteinuria (Group E; 22 patients), or glomerulonephritis in complete remission (Group F; 11 patients).
  
  
  RESULTS
  No significant differences were noted between Group A and the other groups in the international normalized ratio of prothrombin time, activated partial thromboplastin time, and levels of antithrombin and plasminogen. Levels of thrombin-antithrombin (TAT) complexes, fibrinogen, fibrinogen degradation product d-dimers, and plasmin-α2-plasmin inhibitor complexes (PIC) were significantly elevated in Group A. All patients that showed TAT complexes, fibrinogen, and PIC levels greater than 4.2 ng/mL, 399 mg/dL, and 1.4 μg/mL, respectively, had active or progressive systemic amyloidosis. All patients with TAT complex levels less than 3.6 ng/mL, fibrinogen levels less than 355 mg/dL, and PIC levels less than 0.9 μg/mL had localized AL amyloidosis.
  
  
  CONCLUSIONS
  Analyses of TAT complexes, fibrinogen, and PIC can be used to differentiate localized AL amyloidosis from systemic amyloidosis.
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suga
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
authors.forename: Wataru
authors.initials: W
authors.lastname: Kitagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morita
authors.forename: Shogo
authors.initials: S
authors.lastname: Banno
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000378:metabolism; D000686:Amyloidosis / Q000097:blood* / Q000175:diagnosis*; D000991:Antithrombins / Q000097:blood; D001777:Blood Coagulation; D003937:Diagnosis, Differential; D005340:Fibrinogen / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D019934:International Normalized Ratio; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010446:Peptide Fragments / Q000097:blood; D010958:Plasminogen / Q000378:metabolism; D011517:Prothrombin Time; D000685:Serum Amyloid A Protein / Q000378:metabolism; D013917:Thrombin / Q000378:metabolism; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D000682:Amyloid; D000991:Antithrombins; D010446:Peptide Fragments; D000685:Serum Amyloid A Protein; D000979:alpha-2-Antiplasmin; C518669:amyloid L, human; C037742:plasmin-plasmin inhibitor complex; D005340:Fibrinogen; D010958:Plasminogen; D013917:Thrombin; D005341:Fibrinolysin