AMY DA site - i can identify - Video 4

Chapters

• 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.