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Acute deep vein thrombosis with concurrent new diagnosis of AL-amyloid-induced factor X deficiency
  1. Emily Lauren Paton1,
  2. Stefan Barisic1,
  3. Jean Michael Sabile2 and
  4. Eva Medvedova2
  1. 1 Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2 Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health & Science University Knight Cancer Institute, Portland, Oregon, USA
  1. Correspondence to Dr Eva Medvedova; medvedov{at}ohsu.edu

Abstract

Acquired factor X (FX) deficiency is a rare but well-documented clinical feature of AL amyloidosis. Patients with FX deficiency can present with clinically significant bleeding diathesis due to the adsorption of circulating FX to amyloid fibrils. Here, we report an unusual case of a man in his 60s who presented with 6 months of intermittent bruising, labs demonstrating new FX deficiency, elevated free lambda light chains for underlying AL amyloidosis and concurrent new peroneal vein thrombosis. This is the first report of concurrent thrombotic complications in the setting of AL-amyloid-induced FX deficiency. We discuss the diagnostic and therapeutic conundrum of diagnosing AL amyloidosis with bruising as the leading clinical symptom and the management of acute deep vein thrombosis in the setting of FX deficiency.

  • Haematology (incl blood transfusion)
  • Thrombosis

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Footnotes

  • X @StefanBarisicMD, @JeanSabile

  • Contributors The following authors were responsible for drafting the text, sourcing and editing clinical images, investigating results, drawing original diagrams and algorithms and critical revision for important intellectual content: ELP, SB, JMS and EM. The following authors gave final approval of the manuscript: ELP, SB, JMS and EM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.