Algorithm for the Diagnosis of Amyloidosis and Determination of Type - Flowchart
Algorithm for the Diagnosis of Amyloidosis and Determination of Type - Flowchart
«Flowchart»

CLINICAL SUSPICION OF AMYLOIDOSIS

CLINICAL SUSPICION OF AMYLOIDOSIS

CLINICAL SUSPICION OF AMYLOIDOSIS

CLINICAL SUSPICION OF AMYLOIDOSIS LINICAL USPICION OF MYLOIDOSIS

Tissue Biopsy
(Congo red staining of abdominal fat or other tissue)

Tissue Biopsy
(Congo red staining of abdominal fat or other tissue)

Tissue Biopsy
(Congo red staining of abdominal fat or other tissue)

Tissue Biopsy

+

+

+

–

–

–

Identify

Underlying chronic inflammatory disease

Identify

Underlying chronic inflammatory disease

Identify

Identify

Underlying chronic inflammatory disease

Identify

Monoclonal protein in serum or urine
Plasma cell dyscrasia in bone marrow

Identify

Monoclonal protein in serum or urine
Plasma cell dyscrasia in bone marrow

Identify

Identify

Monoclonal protein in serum or urine
Plasma cell dyscrasia in bone marrow


Identify

Mutant ApoAI, ApoAII, fibrinogen, lysozyme, gelsolin

Identify

Mutant ApoAI, ApoAII, fibrinogen, lysozyme, gelsolin

Identify

Identify

Mutant ApoAI, ApoAII, fibrinogen, lysozyme, gelsolin

Immunohistochemical staining of biopsy

Immunohistochemical staining of biopsy

Immunohistochemical staining of biopsy

Immunohistochemical staining of biopsy

Kappa or lambda light chain

Kappa or lambda light chain

Kappa or lambda light chain

Amyloid A protein

Amyloid A protein

Amyloid A protein

Transthyretin

Transthyretin

Transthyretin

Negative

Negative

Negative

Diagnosis

AL amyloidosis (Screen for cardiac, renal, hepatic, autonomic involvement, and factor X deficiency)

Diagnosis

AL amyloidosis (Screen for cardiac, renal, hepatic, autonomic involvement, and factor X deficiency)

Diagnosis

Diagnosis

AL amyloidosis (Screen for cardiac, renal, hepatic, autonomic involvement, and factor X deficiency)

(Screen for cardiac, renal, hepatic, autonomic involvement, and factor X deficiency)

End

End

End

Diagnosis

AA amyloidosis (Screen for renal, hepatic involvement)

Diagnosis

AA amyloidosis (Screen for renal, hepatic involvement)

Diagnosis

Diagnosis

AA amyloidosis (Screen for renal, hepatic involvement)

(Screen for renal, hepatic involvement)

Diagnosis

ATTRm familial amyloidosis (Screen for neuropathy, cardiomyopathy; screen relatives)

Diagnosis

ATTRm familial amyloidosis (Screen for neuropathy, cardiomyopathy; screen relatives)

Diagnosis

Diagnosis

ATTRm familial amyloidosis (Screen for neuropathy, cardiomyopathy; screen relatives)

(Screen for neuropathy, cardiomyopathy; screen relatives)

Diagnosis

ATTRwt or age-related amyloidosis

Diagnosis

ATTRwt or age-related amyloidosis

Diagnosis

Diagnosis

ATTRwt or age-related amyloidosis

Identify

Identify

Identify

Identify

Mutant transthyretin +/– family history

Mutant transthyretin +/– family history

Mutant transthyretin

Wild-type transthyretin (usually males >65, cardiac)

Wild-type transthyretin (usually males >65, cardiac)

Wild-type transthyretin

Diagnosis

Familial amyloidosis of rare type (Screen for renal, hepatic, GI involvement)

Diagnosis

Familial amyloidosis of rare type (Screen for renal, hepatic, GI involvement)

Diagnosis

Diagnosis

Familial amyloidosis of rare type (Screen for renal, hepatic, GI involvement)

(Screen for renal, hepatic, GI involvement)

No further workup

No further workup

No further workup

More invasive biopsy of other affected organ

More invasive biopsy of other affected organ

More invasive biopsy of other affected organ

+

+

+

–

–

–