Interpreting Your Biopsy and Lab Results

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Interpreting Your Biopsy and Lab Results

• Daniel Reilly
• Community Education Specialist
• FactorHealth Management
• 2/10/09

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Disclaimer

• This presentation is for information and
  educational purposes only. Nothing in this
  presentation should be construed or relied upon
  by any individual attending this presentation as
  a medical diagnosis or the delivery of medical
  advice in any way. Participants are advised to
  speak with their physician directly about their
  particular medical circumstances and medical
  information.

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The Liver Biopsy

• Important diagnostic procedure
• Gold standard to assess liver damage
• Provides useful information
• Grade and stage of liver damage
• Hemochromatosis
• Steatosis
• 1/50,000 of liver is removed
• Not done on every patient

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Biopsy Types

• Percutaneous A needle is inserted between the
  ribs on the right side
• Transjugular A catheter is threaded into the
  right jugular vein and then guided to the liver
• Laparoscopic Small incisions are made and a
  devises are inserted under the skin to obtain a
  liver sample
• Surgical Only done if other surgical needs exist

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Metavir Scale - Grade

• Activity or degree of inflammation
• Considered a precursor to fibrosis
• Results are given in a scale of 0-4
• 0 no activity
• 1 mild activity
• 2 moderate activity
• 3 extensive activity
• 4 severe activity

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Metavir Scale - Stage

• Degree of fibrosis (scarring)
• Designed for HCV patients
• 0 no scarring
• 1 minimal scarring
• 2 scarring has occurred and extends outside the
  area in the liver that contains blood vessels
• 3 bridging fibrosis is spreading and connecting
  to other areas that contain fibrosis
• 4 cirrhosis, or advanced scarring of the liver

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Knodell Scale Grade

• Histologic Activity Index (HAI)
• Four individually assigned numbers make up a
  single score to assess inflammation
• Periportal and/or bridging necrosis 0-10
• Intralobular degeneration 0-4
• Portal inflammation 0-4
• 0 no inflammation
• 1-4 minimal inflammation
• 5-8 mild inflammation
• 9-12 moderate inflammation
• 13-18 marked inflammation

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Knodell Scale Stage

• Degree of fibrosis (scarring)
• 0 no scarring
• 1 mild scarring
• 2 moderate scarring
• 3 severe scarring
• 4 extensive scarring (cirrhosis)

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Laboratory Tests

• Results usually given with a reference range
• The range indicates what is normal
• Each lab has their own normal ranges
• Tests that come back out of the normal range are
  usually given either a H or L next to the
  value.

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Complete Blood Count (CBC)

• WBC White Blood Cells (Leukocytes)
• (4,500-11,000/cu MM)
• Neutrophils (40.0-84.0)
• Lymphocytes (20.0-50.0)
• Monocytes (2.0-11.0)
• Eosinophils (0.0-6.0)
• Basophils (0.0-2.0)
• RBC Red Blood Cells (Erythrocytes)
• (4.76-6.09x10(12)/L)
• HGB Hemoglobin (13.9-16.3 g/dl)
• HCT Hematocrit (41.0-53.0)
• PLT Platelets (150,000-400,000/cu MM)

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Liver Function Test (LFT)

• ALT Alanine Aminotransferase (SGPT) (0-40IU/L)
• AST Aspartate Aminotransferase (SGOT) (0-37IU/L)
• Bilirubin Total (0.0-1.3mg/dL)
• Direct Bilirubin (0.0-0.4mg/dL)
• Indirect Bilirubin (0.0-0.9mg/dL)
• Alkaline phosphotase (39-117IU/L)
• Albumin (3.5-5.5g/dL)
• Prothombin time (11-15seconds)

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Chemistry Panel

• Electrolytes
• Sodium
• Potassium
• Chloride
• Calcium
• Iron
• Phosphorus
• Magnesium

• Glucose (60-109mh/dL)
• Lipids (400-800mg/dL)
• Triglycerides
• (10-190mg/dL)
• Cholesterol
• (150-250mg/dL)
• Kidney Function
• Blood urea nitrogen (BUN) (6-23mg/dL)
• Creatinine (0.6-1.3mg/dL)
• Uric acid (1.5-8.0mg/dL)

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HCV Genotype

• 1-6
• Hundreds of sub-species
• Determines length and probability of successful
  treatment
• 75 of US HCV are G1
• 48 weeks
• 50/50 SVR rate
• G 23
• 24 weeks
• 80 SVR rate

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HCV Viral Load

• Qualitative HCV RNA PCR determines if virus is
  present in the blood
• Positive or Negative
• Quantitative HCV RNA PCR determines the amount
  of virus in 1 ml of blood
• lt400,000IU/ml (low)
• lt2,000,000 copies/ml (low)
• Can be measured lt10 IU/ml
• No upper limit

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HCV Viral Load

• No correlation between HCV viral load and the
  amount of liver damage.
• Used to determine if treatment is working.
• A 2 log drop in viral load is calculated by
  removing two zeros off of the end of the number
• i.e. 2,000,000 IU/ml becomes 20,000 IU/ml.
• Used to determine if SVR is achieved.
• Six months after treatment stops, viral load
  remains undetectable.

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HIV Co-infection Lab Tests

• CD4 (T-cells)
• The absolute will probably decrease during HCV
  treatment
• The should remain stable
• HIV Viral Load
• Usually not affected by HCV treatment

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FibroSure Test

• Non-invasive liver biopsy
• Looks at markers in the blood to determine amount
  of liver damage
• Not widely used in US yet
• Fibrosis stage (Fibro test)
• F0 - no fibrosis 0.00-0.21
• F0-F1 0.21-0.27
• F1 - portal fibrosis 0.27-0.31
• F1-F2 0.31-0.48
• F2 - bridging fibrosis with few septa 0.48-0.58
• F3 - bridging fibrosis with many septa 0.58-0.72
  
• F3-F4 0.72-0.74
• F4 - cirrhosis 0.74-1.00
• Activity grade (ActiTest)
• A0 - no activity 0.00-0.17
• A0-A1 0.17-0.29
• A1 - minimal activity 0.29-0.36
• A1-A2 0.36-0.52
• A2 - moderate activity 0.52-0.60
• A2-A3 0.60-0.63

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Alpha-fetoprotein (AFP)

• An antigen produced in the liver of a fetus that
  can appear in certain diseases of adults, such as
  liver cancer.
• Range lt40micrograms/L

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In Conclusion

• Always get printed copies of your lab work from
  your healthcare provider.
• Ask your healthcare provider if your lab results
  are available online.
• If you do not understand something, ask your
  doctor for clarification until it is clear to
  you.
• If your physician orders a test that you are not
  familiar with, ask for an explanation of why the
  test was ordered and what the test is looking
  for.