Differential diagnosis of localized and systemic amyloidosis based on coagulation and fibrinolysis parameters

Amyloid. 2012 Jun;19(2):61-5. doi: 10.3109/13506129.2012.663425. Epub 2012 Mar 15.


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.

Conclusion: Analyses of TAT complexes, fibrinogen, and PIC can be used to differentiate localized AL amyloidosis from systemic amyloidosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyloid / metabolism
  • Amyloidosis / blood*
  • Amyloidosis / diagnosis*
  • Antithrombins / blood
  • Blood Coagulation
  • Diagnosis, Differential
  • Fibrinogen / metabolism
  • Fibrinolysin / metabolism
  • Fibrinolysis
  • Humans
  • International Normalized Ratio
  • Middle Aged
  • Partial Thromboplastin Time
  • Peptide Fragments / blood
  • Plasminogen / metabolism
  • Prothrombin Time
  • Serum Amyloid A Protein / metabolism
  • Thrombin / metabolism
  • alpha-2-Antiplasmin / metabolism


  • Amyloid
  • Antithrombins
  • Peptide Fragments
  • Serum Amyloid A Protein
  • alpha-2-Antiplasmin
  • amyloid L, human
  • plasmin-plasmin inhibitor complex
  • Fibrinogen
  • Plasminogen
  • Thrombin
  • Fibrinolysin