Table 2. Presymptomatic hints, symptoms,... | American Society of Hematology

Table 2.

Presymptomatic hints, symptoms, and signs leading to the diagnosis of AL amyloidosis

Presymptomatic	Symptomatic
Presymptomatic	Organ involved	Symptoms	Signs
Increased markers of possible amyloid organ involvement: • Heart: NT-proBNP • Kidney: Albuminuria • Liver: Alkaline phosphatase Monitored during follow-up of MGUS patients and particularly in those with abnormal FLC ratio, and LC propensity to form amyloid (glycosylated κ LCs, use of LC genes IGLV6-57, IGLV2-14, IGLV1-44, and LCs identified by machine learning algorithm)	Heart	Reduced exercise tolerance Dyspnea at rest or exertion Fatigue Syncope Angina	Lower extremity edema Pleural effusions Jugular vein distension Arrhythmia Thickened ventricular walls and low voltages on ECG
	Kidney	Loss of appetite Fatigue and weakness	Lower extremity edema Anasarca
	Soft tissues	Jaw or buttock claudication Carpal tunnel (often bilateral) Dysarthria	Periorbital (upper body) purpura Macroglossia Nail dystrophy Shoulder pad Arthropathy Myopathy
	Peripheral nervous system including autonomic nervous system	Length dependent sensory-motor neuropathy Lipothymia Taste alterations Early satiety	Orthostatic hypotension Intestinal dysmotility Erectile dysfunction Voiding dysfunction
	Liver	Right upper quadrant tenderness Jaundice Early satiety	Hepatomegaly Weight loss
	Gastrointestinal tract	Abdominal discomfort	Malabsorption Gastrointestinal bleeding Diarrhea Weight loss

Presymptomatic	Symptomatic
Presymptomatic	Organ involved	Symptoms	Signs
Increased markers of possible amyloid organ involvement: • Heart: NT-proBNP • Kidney: Albuminuria • Liver: Alkaline phosphatase Monitored during follow-up of MGUS patients and particularly in those with abnormal FLC ratio, and LC propensity to form amyloid (glycosylated κ LCs, use of LC genes IGLV6-57, IGLV2-14, IGLV1-44, and LCs identified by machine learning algorithm)	Heart	Reduced exercise tolerance Dyspnea at rest or exertion Fatigue Syncope Angina	Lower extremity edema Pleural effusions Jugular vein distension Arrhythmia Thickened ventricular walls and low voltages on ECG
	Kidney	Loss of appetite Fatigue and weakness	Lower extremity edema Anasarca
	Soft tissues	Jaw or buttock claudication Carpal tunnel (often bilateral) Dysarthria	Periorbital (upper body) purpura Macroglossia Nail dystrophy Shoulder pad Arthropathy Myopathy
	Peripheral nervous system including autonomic nervous system	Length dependent sensory-motor neuropathy Lipothymia Taste alterations Early satiety	Orthostatic hypotension Intestinal dysmotility Erectile dysfunction Voiding dysfunction
	Liver	Right upper quadrant tenderness Jaundice Early satiety	Hepatomegaly Weight loss
	Gastrointestinal tract	Abdominal discomfort	Malabsorption Gastrointestinal bleeding Diarrhea Weight loss