Page 298 - Essential Haematology

284 / Chapter 21 Multiple myeloma and related disorders

(a)

Figure 21.10 Amyloidosis:
(a) Congo red staining and
(b) blue – green birefringence
(b) under polarized light.

Systemic AL a myloidosis ropathy, carpal tunnel syndrome or renal failure. A
serum amyloid P (SAP) scan (Fig. 21.12 ) is used to
Systemic amyloid light chain (AL) amyloid disease determine the extent and severity of disease.
is caused by deposition of monoclonal light chains Treatment is with chemotherapy similar to that
produced from a clonal plasma cell proliferation. used in myeloma, possibly with autologous SCT,

The level of paraprotein may be very low and is not which may improve prognosis.
always detectable in serum or urine but the serum
free light chain ratio is usually abnormal (Fig. 21.4 ).
The clinical features are caused by involvement of Hyperviscosity s yndrome

the heart, tongue (Fig. 21.11 ), peripheral nerves
and kidneys (Fig. 21.7 ), and the patient may present Th e most common cause is polycythaemia (see p.
with heart failure, macroglossia, peripheral neu- 204 ) . Hyperviscosity may also occur in patients