When to suspect AL amyloidosis
Symptoms depend on which organs are involved. Common presentations include fatigue, swelling, protein in the urine, heart failure, neuropathy, purpura, an enlarged tongue or unexplained weight loss. The combination of a monoclonal protein with organ dysfunction should prompt assessment.
AL amyloidosis can occur with multiple myeloma or MGUS, but it can also occur without a known plasma-cell disorder.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
Diagnosis and organ assessment
Testing includes serum and urine protein electrophoresis with immunofixation, serum free light chains and a tissue biopsy with Congo red staining. Bone marrow examination looks for the plasma-cell clone.
Cardiac, renal, hepatic, neurological and gastrointestinal involvement is assessed because organ staging guides treatment and prognosis. A careful review distinguishes AL amyloidosis from other amyloid types.
- Serum and urine immunofixation
- Free light chain ratio
- Congo red biopsy of an involved organ or fat pad
- Cardiac and renal assessment
Treatment and monitoring
Treatment targets the abnormal plasma-cell clone, using regimens similar to those used in multiple myeloma. Selected patients may be considered for autologous transplant. Supportive care addresses heart failure, kidney disease, neuropathy and nutrition.
Response is monitored with free light chains, organ function and symptoms. Early haematological response is important because it can limit further organ damage.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, marrow, flow cytometry and molecular reports.