Abstract
This report describes a patient with chronic renal failure who showed severe bleeding tendencies after 16 years of hemodialysis. He was a 40-year-old man who had been on hemodialysis since 1972 under a diagnosis of chronic renal failure due to chronic glomerulonephritis. Bleeding tendencies such as systemic purpura and gingival bleeding appeared in August 1988. His platelet count was 10.1×104/μl, and platelet agglutination and adhesion capacity were severely depressed. A high serum IgA value (1, 148mg/dl) and the appearance of an M bow in IgA γ in immunoelectorophoresis led us to suspect myeloma. We treated his bleeding tendencies with non-heparinized hemodialysis and plasma exchange, but he showed upper gastrointestinal bleeding. He also received chemotherapy (cyclophosphamide, vincristine), but he died of liver failure in June 1989. Pathological examination revealed systemic AL amyloidosis and diffuse bone marrow invasion of mild atypical plasma cells. In multiple myeloma, nodular proliferation of plasma cells is characteristic, but it was not observed in this case.
We assumed that the bleeding tendencies were due to amyloid infiltration of the blood vessels.
