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Interpreting Your Biopsy and Lab Results

Daniel ReillyCommunity 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 2&3 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 <400,000IU/ml (low) <2,000,000 copies/ml (low) Can be measured <10 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 A3 - severe activity: 0.63-1.00

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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: <40micrograms/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.