Amyloidosis




Risk




  • •

    Incidence in USA: 1:100,000


  • •

    Race with highest prevalence: Unknown





Perioperative Risks




  • •

    Increased risk of periop renal failure, cardiomyopathy (arrhythmias and ventricular dysfunction), bleeding from coagulopathy


  • •

    Autonomic neuropathy





Perioperative Risks




  • •

    Increased risk of periop renal failure, cardiomyopathy (arrhythmias and ventricular dysfunction), bleeding from coagulopathy


  • •

    Autonomic neuropathy





Worry About




  • •

    Signs of CHF


  • •

    Dysrhythmias


  • •

    Decreasing urine output





Overview




  • •

    Extracellular deposition of amyloid-type proteins.


  • •

    Congo-red stain of tissue reveals green birefringence in a polarizing microscope.


  • •

    Associated end-stage renal, myocardial, and neuropathic disease.


  • •

    Best diagnosed by subcutaneous abdominal fat pad aspirate or rectal biopsy.





Etiology




  • •

    Both acquired and hereditary forms exist.


  • •

    Acquired forms are categorized as primary (AL), associated with plasma cell disorders (i.e., multiple myeloma), and secondary (AA), associated with inflammatory and infectious diseases (e.g., osteomyelitis, rheumatoid arthritis).


  • •

    Hereditary forms very rare.





Usual Treatment




  • •

    Acquired: Treatment of primary (AL) amyloidosis is directed at the underlying plasma cell disorder (e.g., chemotherapy, stem cell transplant). Treatment of secondary (AA) amyloidosis is directed at underlying infection/inflammation.


  • •

    Hereditary: Colchicine, liver transplantation.


  • •

    Treatments to clear amyloid deposits are being developed.


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Sep 1, 2018 | Posted by in ANESTHESIA | Comments Off on Amyloidosis

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