Transcript Interpreting Your Biopsy and Lab Results

Interpreting Your Biopsy
and Lab Results
Daniel Reilly
Community Education Specialist
FactorHealth Management
2/10/09
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Disclaimer
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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
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Important diagnostic procedure
Gold standard to assess liver damage
Provides useful information
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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
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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
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Activity or degree of inflammation
Considered a precursor to fibrosis
Results are given in a scale of 0-4
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0 = no activity
1 = mild activity
2 = moderate activity
3 = extensive activity
4 = severe activity
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Metavir Scale - Stage
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Degree of fibrosis (scarring)
Designed for HCV patients
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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
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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
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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
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Degree of fibrosis (scarring)
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0 = no scarring
1 = mild scarring
2 = moderate scarring
3 = severe scarring
4 = extensive scarring (cirrhosis)
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Laboratory Tests
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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)
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WBC: White Blood Cells (Leukocytes)
(4,500-11,000/cu MM)
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RBC: Red Blood Cells (Erythrocytes)
(4.76-6.09x10(12)/L)
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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%)
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)
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ALT: Alanine Aminotransferase (SGPT) (0-40IU/L)
AST: Aspartate Aminotransferase (SGOT) (0-37IU/L)
Bilirubin Total: (0.0-1.3mg/dL)
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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
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Electrolytes
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Sodium
Potassium
Chloride
Calcium
Iron
Phosphorus
Magnesium
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Glucose (60-109mh/dL)
Lipids (400-800mg/dL)
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Triglycerides
(10-190mg/dL)
Cholesterol
(150-250mg/dL)
Kidney Function
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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
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1-6
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Determines length and probability of successful
treatment
75% of US HCV are G1
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Hundreds of sub-species
48 weeks
50/50 SVR rate
G 2&3
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24 weeks
80% SVR rate
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HCV Viral Load
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Qualitative HCV RNA PCR: determines if
virus is present in the blood
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Positive or Negative
Quantitative HCV RNA PCR: determines the
amount of virus in 1 ml of blood
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<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
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No correlation between HCV viral load and
the amount of liver damage.
Used to determine if treatment is working.
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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.
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Six months after treatment stops, viral load
remains undetectable.
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HIV Co-infection Lab Tests
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CD4 (T-cells)
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The absolute # will probably decrease during HCV
treatment
The % should remain stable
HIV Viral Load
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Usually not affected by HCV treatment
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FibroSure Test
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Non-invasive liver biopsy
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Fibrosis stage (Fibro test):
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Looks at markers in the blood to determine amount of liver damage
Not widely used in US yet
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):
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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)
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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
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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.
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