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AMY DA site - i can identify - Video 4
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00:00:15
Patients with monoclonal gammopathy of unknown significance,
00:00:20
smoldering multiple myeloma, or multiple myeloma,
00:00:25
when they present with unusual features of macroglossia
00:00:33
periorbital ecchymosis or racoon eyes,
00:00:36
or zero negative rheumatoid arthritis,
00:00:41
AL amyloidosis should be suspected and ruled out.
00:00:46
Patients who present with coagulopathy
00:00:50
related to acquired Factor X deficiency,
00:00:54
AL amyloidosis should always be in the differential diagnosis.
00:01:00
Patients with monoclonal gammopathy of unknown significance,
00:01:04
smoldering myeloma or myeloma presenting with heart failure,
00:01:11
shortness of breath, peripheral edema not related to steroids
00:01:16
should always be assessed for AL amyloidosis.
00:01:20
Congo red staining should be performed to rule out AL amyloidosis
00:01:26
as bone marrow biopsies with Congo red stain
00:01:30
can be positive in about 50% of the patients with AL amyloidosis.
00:01:42
I think it is crucial that the subspecialties collaborate with each other,
00:01:48
speak to each other, and see patients at the same time
00:01:52
to make the diagnosis quicker, easier, and emergently
00:01:58
so that the end organ function is preserved and does not deteriorate rapidly.
00:02:04
The other specialties besides hematology oncology and cardiology
00:02:09
are nephrology, neurology, as well as sometimes gastroenterology.
00:02:15
But I feel that the primary care doctors are the gatekeepers of healthcare system,
00:02:22
and raising awareness and having a high index of suspicion for a patient
00:02:28
with multiorgan involvement, multiorgan symptoms, is critical
00:02:35
for a primary care doctor to keep this diagnosis in mind.
00:02:39
As a systemic disease, there’s going to be other manifestations
00:02:42
that raise suspicion for AL cardiac amyloidosis.
00:02:46
And I think that’s what we do so well here at Boston University
00:02:50
where we all work together with multiple specialties,
00:02:54
and all of us see a single patient and then we discuss that patient in a group.
00:03:00
That also has implications for treatment, and Dr. Sanchorawala can talk more about that,
00:03:04
but people with cardiac amyloidosis may not tolerate certain treatments as well.
00:03:11
And so that’s really important to have a cardiologist who can talk to
00:03:14
the hematologist about the ability of a patient to tolerate certain therapies.
00:03:20
It is obtaining diagnosis quickly and non-invasively as possible.
00:03:26
And then, once the diagnosis is obtained, it is crucial to collaborate,
00:03:31
because the treatment side effects can be managed
00:03:34
by a multidisciplinary team appropriately.