Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 Me again... Okay, I need a crash course in Hep C 101.... I've been doing research. My husband was just diagnosed with Hep C. He goes for a biopsy on Friday. The doc talks about levels and all this other stuff like his iron count ALT <---is that even the right thing? Anyways, since we will see him again before/after the biopsy I was wondering if ya'll could help me out with the IMPORTANT QUESTIONS. I have some already, and some ones that I think he may consider sill, so the heading in my date book is IMPORTANT QUESTIONS. Can ya'll think of any others. What levels and such do we need to be concerned with? Thanks in advance! ANY and EVERYTING will be greatly appreciated. Hope eveyone has a good day! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 The following is a list of bad signs: Albumin - below normal Protein - below normal Bilirubin - above normal BUN - above normal creatinine - above normal PT time or INR - above normal, this is a special test ordered to see how fast his blood is clotting. =========== Lab Tests Meanings & Normal Values Hematology Hematocrit, (HCT) The word hematocrit means to separate blood, a procedure which is followed following the blood draw through the proper use of a centrifuge. Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased) , polycythemia (increased), dehydration (elevated), increased R.B.C. breakdown in the spleen (elevated), or possible overhydration (elevated) Normal Adult Female Range: 37 - 47% Optimal Adult Female Reading: 42% Normal Adult Male Range 40 - 54% Optimal Adult Male Reading: 47 Normal Newborn Range: 50 - 62% Hemoglobin (HGB) Hemoglobin is the main transport of oxygen and carbon dioxide in the blood. It is composed of globin a group of amino acids that form a protein and heme which contains iron atoms and the red pigment, porphyrin. As with Hematocrit, it is an important determinant of anemia (decreased), dehydration (increased), polycythemia (increased), poor diet/nutrition, or possibly a malabsorption problem. Normal Adult Female Range: 12 - 16% Optimal Adult Female Reading: 14 Normal Adult Male Range: 14 - 18% Optimal Adult Male Reading: 16 Normal Newborn Range: 14 - 20% MCH (Mean Corpuscular Hemoglobin) Hemoglobin x 10 Mean Corpuscular Hemoglobin (MCH) gives the average weight of hemoglobin in the red blood cell. Due to its use of red blood cells in its calculation, MCH is not as accurate as MCHC in its diagnosis of severe anemia's. Decreased MCH is associated with microcytic anemia and increased MCH is associated with macrocytic anemia. Normal Adult Range: 27 - 33 pg MCV Mean Corpuscular Volume Hematocrit x 10 R.B.C. The Mean Corpuscular Volume reflects the size of red blood cells by expressing the volume occupied by a single red blood cell. Increased readings may indicate macrocytic anemia or B6 or Folic Acid deficiency and decreased readings may indicate microcytic anemia, possibly caused by iron deficiency. Normal Adult Range: 80 - 100 fl Optimal Adult Reading: 90 MCHC (Mean Corpuscular Hemoglobin Concentration) Hemoglobin x 100 This test measures the average concentration of hemoglobin in red blood cells. It is most valuable in evaluating therapy for anemia because Hemoglobin and Hematocrit are used, not R.B.C. in the calculation. Low MCHC means that a unit of packed R.B.C's contain less hemoglobin than normal and a high MCHC means that there is more hemoglobin in a unit of R.B.C.'s. Increased MCHC is seen in spherocytosis, and not seen in pernicious anemia whereas decreased levels may indicate iron deficiency, blood loss, B6 deficiency of thalassemia. Normal Adult Range: 32 - 36 % Optimal Adult Reading: 34 R.B.C. (Red Blood Cell Count) Red blood cells main function is to carry oxygen to the tissues and to transfer carbon dioxide to the lungs. This process is possible through the R.B.C. containing hemoglobin which combines easily with oxygen and carbon dioxide. Normal Adult Female Range: 3.9 - 5.2 mill/mcl Optimal Adult Female Reading: 4.55 Normal Adult Male Range: 4.2 - 5.6 mill/mcl Optimal Adult Male Reading: 4.9 W.B.C. (White Blood Cell Count) White blood cells main function is to fight infection, defend the body by phagocytosis against invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the immune response. There are a number of types of leukocytes (see differential) that are classified as follows: GranulocytesNongranulocytes Band NeutrophilesLymphocytes NeutrophilsMonocytes Eosinophils Basophils Each cell, or leukocyte, has a different job in the body which is explained in the Differential section. Normal Adult Range: 3.8 - 10.8 thous/mcl Optimal Adult Reading: 7.3 Platelet Count Platelets (also known as thrombocytes) are the smallest formed elements of the blood. They are vital to coagulation of the blood to prevent excessive bleeding. Elevated levels suggest dehydration or stimulation of the bone marrow where the cells are produced and decreased levels may indicate an immune system failure, drug reactions, B12 or folic acid deficiency. Normal Adult Range: 130 - 400 thous/mcl Optimal Adult Reading: 265 Electroylytes Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Normal Adult Range: 135-146 mEq/L Potassium is the major intracellular cation in the blood. It, along with sodium, helps to maintain osmotic balance and in also involved in acid-base balance. It is needed for proper nerve and muscle action. Normal Range: 3.5 - 5.5 mEq/L Chlorides significance relates to its maintenance of cellular integrity through it influence on osmotic pressure, it also helps monitor acid-base balance and water balance. Elevated levels are related to acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water deficiency crossing the cell membrane (edema). Normal Adult Range: 95-112 mEq/L CO2 Content (Carbon Dioxide) The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity. Normal Adult Range: 22-32 mEq/L Optimal Adult Reading: 27 Normal Childrens Range - 20 - 28 mEq/L Calcium The most abundant mineral in the body, it is involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. It is highly sensitive to elements such as magnesium, iron and phosphorus as well as hormonal activity, vitamin D levels, alkalinity and acidity, and many drugs. Normal Adult Range: 8.5-10.3 mEq/dl Phosphorus is an abundant element found in most tissues and cells. It is closely related to the calcium level with an inverse relationship. When calcium is increased, phosphorus tends to decrease and vice versa. Careful following of blood draw procedures are necessary because improper handling may cause false elevated readings. Phosphorus is needed for its buffering action, calcium transport and osmotic pressure. Normal Adult Range: 2.5 - 4.5 mEq/dl Optimal Adult Reading: 3.5 Normal Childrens Range: 3 - 6 mEq/dl Liver Enzymes AST/SGOT (Serum Glutamic-Oxalocetic Transaminase - AST) Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the liver, heart, kidney, pancreas, and muscles. Seen in tissue damage, especially heart and liver, this enzyme is normally elevated. Vitamin B deficiency and pregnancy are two instances where the enzyme may be decreased. Normal Adult Range: 0 - 42 U/L ALT/SGPT (Serum Glutamic-Pyruvic Transaminase - ALT) Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the liver but also to a lesser degree, the heart and other tissues. It is useful in diagnosing liver function more so than SGOT levels. Decreased SGPT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction. Normal Adult Range: 0 - 48 U/L Alkaline Phosphatase Produced in the cells of the bone and liver with some activity in the kidney, intestine, and placenta, it is mostly found in an alkaline state with a pH of 9. Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated readings). Growing children have normally higher levels of this enzyme also. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies. Normal Adult Range: 20 - 125 U/L Optimal Adult Reading: 72.5 Normal Childrens Range: 40 - 400 U/L GGT (Gamma-Glutamyl Transpeptidase) Believed to be involved in the transport of amino acids and peptides into cells as well as glutithione metabolism, Gamma-Glutamyl Transpeptidase is mainly found in liver cells and as such is extremely sensitive to alcohol use. Elevated levels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium. Normal Adult Female Range: 0 - 45 U/L Optimal Female Reading: 22.5 Normal Adult Male Range: 0 - 65 U/L LDH (Lactic Acid Dehydrogenase) Lactic acid dehydrogenase is an intracellular enzyme from particularly in the kidney, heart, skelatal muscle, brain, liver and lungs. Increases are usually found in cellular death and/or leakage from the cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity. Normal Adult Range: 0 - 250 U/L Optimal Adult Reading: 125 Panels: Cardiac Marker, Kidney Function, Liver Bilirubin, Total A byproduct of the breakdown of red blood cells in the liver, bilirubin is a good indication of the liver’s function. Excreted into the bile, bilirubin gives the bile its pigmentation. Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods. Normal Adult Range 0 - 1.3 mg/dl Nitrogen Elements (Blood Urea Nitrogen) (BUN) The nitrogen component of urea, B.U.N. is the end product of protein metabolism and its concentration is influenced by the rate of excretion. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be dur to a poor diet, malabsorption, liver damage or low nitrogen intake. Normal Adult Range: 7 - 25 mg/dl Creatinine is the waste product of muscle metabolism. Its level is a reflection of the bodies muscle mass. Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function. Normal Adult Range: .7 - 1.4 mg/dl Uric acid is the end product of purine metabolism and is normally excreted through the urine. High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney. Normal Adult Female Range: 2.5 - 7.5 mg/dl Optimal Adult Female Reading: 5.0 Normal Adult Male Range: 3.5 - 7.5 mg/dl Protein,Total Proteins are the most abundant compound in serum. The protein makeup of the individual is of important diagnostic significance because of proteins involvement in enzymes, hormones and antibodies as well as osmotic pressure balance, maintaining acid-base balance and as a reserve source of nutrition for the bodies tissues and muscles. The major serum proteins measured are Albumin and Globulin (alpha1, alpha2, beta and gamma). Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others. Careful review of the individuals albumin, globulin and A/G ratio are recommended. Normal Adult Range: 6.0 -8.5 g/dl Optimal Adult Reading: 7.25 Panels: Kidney Function, Liver Function, Protein Albumin is the major constituent of serum protein (usually over 50%). It is manufactured by the liver from the amino acids taken through the diet. It helps in osmotic pressure regulation, nutrient transport and waste removal. High levels are seen rarely in liver disease, shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcemia. Panels: Kidney Function, Liver Function, Protein Normal Adult Range: 3.2 - 5.0 g/dl Globulin, a larger protein than albumin, is important for its immunologic responses, especially its gamma portion (IgA, IgG, IgM, and IgE).. Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies. When chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, elevated levels are seen. You may find lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease. Normal Adult Range: 2.2 - 4.2 g/dl (calculated) Optimal Adult Reading: 3.2 Panels: Allergy, Kidney Function, Liver A/G ratio (Albumin/Globulin Ratio) is an important indicator of disease states although a high level is not considered clinically significant. Normal Adult Range: 0.8 - 2.0 (calculated) Optimal Adult Reading: 1.9 Panels: Protein, Kidney Function, Liver Lipids Cholesterol Cholesterol is a critical fat that is a structural component of cell membrane and plasma lipoproteins, and is important in the synthesis Process. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 Biopsies Still Better for Determining Hepatitis C Liver Damage Biopsies are still better for determining the extent of liver damage in hepatitis C patients despite recent studies showing the effectiveness of blood tests. Writing in the May issue of Hepatology, Dr. Nezam H. Afdhal, of Beth Israel Deaconess Medical Center in Boston, said the ability to determine the degree of liver injury or to predict the risk of liver disease progression for the patient still requires an "old-fashioned" liver biopsy. Clinicians use biopsies to determine the need for therapy. Afdhal said the complexity and side effects of interferon-based therapies for the disease have increased the role of the liver biopsy in the decision on whether to treat a patient. Patients with significant liver fibrosis or moderate inflammation are all considered suitable for therapy, whereas patients with milder disease are often not as aggressively offered treatment. However, as newer, better-tolerated and more effective therapies are developed, Afdhal said the need to biopsy all hepatitis C patients to gauge the severity of their condition could become redundant. "Therefore, the development of noninvasive tests that can differentiate between patients with mild disease versus those with more significant fibrosis could have a widespread clinical utility in managing hepatitis C patients in the future," said Afdhal. Afdhal said it could be argued that blood tests can categorize almost a third of patients into those with mild liver disease and use this information for decision analysis without a liver biopsy. "Unfortunately, there is somewhat of a rush to commercialize these so-called tests of liver fibrosis without rigorous scientific validation," Afdhal observed. NOTE From Vikki: Ask your Dr. BEFORE biospy what kind of drugs he will be giving you before he preforms the biospy. ASK FOR "VERSED". You will remain awake but your really not aware of what is going on. Patients have the right to have their pain treated. Source: Hepatalogy =========== The standard approach to percutaneous liver biopsy is diagrammed here. The needle is passed between two ribs into the liver, suction is applied, and a core of liver aspirated. By entering the liver in the mid to posterior axillary line, and by pointing the needle both cephalad and ventrad, the operator can safely sample the widest area of liver and avoid the major vessels and bile ducts. The biopsy illustrated here is taken from a patient with chronic active hepatitis of unknown etiology with progression to post necrotic cirrhosis. There is a large regenerative nodule in the center of the field surrounded by the blue of a fibrous septum. This disruption of the normal lobular architecture with the presence of well defined nodules is the biopsy finding which defines cirrhosis (Masson's trichrome stain, X 4). Liver biopsy has the advantage of being the only technique which actually demonstrates hepatic histology. It also allows for biochemical assays on liver tissue, such as hepatic iron measurement in patients being evaluated for hemochromatosis. Liver biopsy is limited by the fact that it is an invasive technique and it should therefore be reserved until other diagnostic avenues have been exhausted. There are a variety of contraindications to its use, including coagulopathy, an uncooperative or clinically unstable patient, and certain hepatic diagnoses, including hemangioma. Potential complications include bleeding, into either the peritoneum or binary tree (hemobilia), puncture of the lung with resultant pneumothorax, puncture of a major bile duct or the gallbladder with subsequent bile leak and bile peritonitis, and sepsis due to connection of an infected binary tree with the systemic circulation. Finally, liver biopsy interpretation is highly dependent on the skill of the pathologist and on input from the clinician. The importance of this procedure in the accurate diagnosis of liver disease is underlined by the fact that, in up to 25% of cases, even the most experienced of hepatologists has made an incorrect clinical diagnosis that is altered by knowledge of the histology. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 http://cpmcnet.columbia.edu/dept/gi/labtests.html This link and many other medical and hep support links may be found at the HepCURE website. www.junction.net/hepcure HepCURE is a non-profit society dedicated to supporting scientific research into a cure for hepatitis C and support for the HCV infected. Common Laboratory Tests in Liver Diseases J. Worman, M. D. The diagnosis of liver diseases depends upon a combination of history, physical examination, laboratory testing and sometimes radiological studies and biopsy. Only a physician who knows all of these aspects of a specific case can reliably make a diagnosis. Many individuals with liver diseases nonetheless have questions about their laboratory test results and seek information about their significance. The purpose of this page is to briefly describe some of the common laboratory tests that may be abnormal in individuals with liver diseases. Patients reading this page must keep in mind that abnormalities of these laboratory tests are not diagnostic of specific diseases and that only a qualified physician who knows the entire case can provide a reliable diagnosis. Alanine aminotransferase (ALT) ALT is an enzyme produced in hepatocytes, the major cell type in the liver. ALT is often inaccurately referred to as a liver function test, however, its level in the blood tells little about the function of the liver. The level of ALT in the blood (actually enzyme activity is measured in the clinical laboratory) is increased in conditions in which hepatocytes are damaged or die. As cells are damaged, ALT leaks out into the bloodstream. All types of hepatitis (viral, alcoholic, drug-induced, etc.) cause hepatocyte damage that can lead to elevations in the serum ALT activity. The ALT level is also increased in cases of liver cell death resulting from other causes, such as shock or drug toxicity. The level of ALT may correlate roughly with the degree of cell death or inflammation, however, this is not always the case. An accurate estimate of inflammatory activity or the amount cell death can only be made by liver biopsy. (See also aspartate aminotransferase below.) Aspartate aminotransferase (AST) AST is an enzyme similar to ALT (see above) but less specific for liver disease as it is also produced in muscle and can be elevated in other conditions (for example, early in the course of a heart attack). AST is also inaccurately referred to as a liver function test by many physicians. In many cases of liver inflammation, the ALT and AST activities are elevated roughly in a 1:1 ratio. In some conditions, such as alcoholic hepatitis or shock liver, the elevation in the serum AST level may higher than the elevation in the serum ALT level. Alkaline phosphatase Alkaline phosphatase is an enzyme, or more precisely a family of related enzymes, produced in the bile ducts, intestine, kidney, placenta and bone. An elevation in the level of serum alkaline phosphatase (actually enzyme activity is measured in the clinical laboratory), especially in the setting of normal or only modestly elevated ALT and AST activities, suggests disease of the bile ducts. Serum alkaline phosphatase activity can be markedly elevated in bile duct obstruction or in bile duct diseases such as primary biliary cirrhosis or primary sclerosing cholangitis. Alkaline phosphatase is also produced in bone and blood activity can also be increased in some bone disorders. Gamma-glutamyltranspeptidase (GGT) An enzyme produced in the bile ducts that, like alkaline phosphatase, may be elevated in the serum of patients with bile duct diseases. Elevations in serum GGT, especially along with elevations in alkaline phosphatase, suggest bile duct disease. Measurement of GGT is an extremely sensitive test, however, and it may be elevated in virtually any liver disease and even sometimes in normal individuals. GGT is also induced by many drugs, including alcohol, and its serum activity may be increased in heavy drinkers even in the absence of liver damage or inflammation. Bilirubin Bilirubin is the major breakdown product that results from the destruction of old red blood cells (as well as some other sources). It is removed from the blood by the liver, chemically modified by a process call conjugation, secreted into the bile, passed into the intestine and to some extent reabsorbed from the intestine. Bilirubin concentrations are elevated in the blood either by increased production, decreased uptake by the liver, decreased conjugation, decreased secretion from the liver or blockage of the bile ducts. In cases of increased production, decreased liver uptake or decreased conjugation, the unconjugated or so-called indirect bilirubin will be primarily elevated. In cases of decreased secretion from the liver or bile duct obstruction, the conjugated or so-called direct bilirubin will be primarily elevated. Many different liver diseases, as well as conditions other than liver diseases (e. g. increased production by enhanced red blood cell destruction), can cause the serum bilirubin concentration to be elevated. Most adult acquired liver diseases cause impairment in bilirubin secretion from liver cells that cause the direct bilirubin to be elevated in the blood. In chronic, acquired liver diseases, the serum bilirubin concentration is usually normal until a significant amount of liver damage has occurred and cirrhosis is present. In acute liver disease, the bilirubin is usually increased relative to the severity of the acute process. In bile duct obstruction, or diseases of the bile ducts such as primary biliary cirrhosis or sclerosing cholangitis, the alkaline phosphatase and GGT activities are often elevated along with the direct bilirubin concentration. Albumin Albumin is the major protein that circulates in the bloodstream. Albumin is synthesized by the liver and secreted into the blood. Low serum albumin concentrations indicate poor liver function. The serum albumin concentration is usually normal in chronic liver diseases until cirrhosis and significant liver damage is present. Albumin levels can be low in conditions other than liver diseases including malnutrition, some kidney diseases and other rarer conditions. Prothrombin time (PT) Many factors necessary for blood clotting are made in the liver. When liver function is severely abnormal, their synthesis and secretion into the blood is decreased. The prothrombin time is a type of blood clotting test performed in the laboratory and it is prolonged when the blood concentrations of some of the clotting factors made by the liver are low. In chronic liver diseases, the prothrombin time is usually not elevated until cirrhosis is present and the liver damage is fairly significant. In acute liver diseases, the prothrombin time can be prolonged with severe liver damage and return to normal as the patient recovers. Prothrombin time can also be prolonged in cases of vitamin K deficiency, by drugs (warfarin, used therapeutically as an anti-coagulant, prolongs the prothrombin time) and in non-liver disorders. Platelet count Platelets are the smallest of the blood cells (actually fragments of larger cells known as megakaryocytes) that are involved in clotting. In some individuals with liver disease, the spleen becomes enlarged as blood flow through the liver is impeded. This can lead to platelets being sequestered in the enlarged spleen. In chronic liver diseases, the platelet count usually falls only after cirrhosis has developed. The platelet count can be abnormal in many conditions other than liver diseases. Serum protein electrophoresis In this test, the major proteins in the serum are separated in an electric field and their concentrations determined. The four major types of serum proteins whose concentrations are measured in this test are albumin, alpha-globulins, beta-globulins and gamma-globulins. Serum protein electrophoresis is a useful test in patients with liver diseases as it can provide clues to several diagnostic possibilities. In cirrhosis, the albumin may be decreased (see above) and the gamma-globulin elevated. Gamma-globulin can be significantly elevated in some types of autoimmune hepatitis. The alpha-globulins can be low in alpha-1-antitrypsin deficiency. ================= Source: Hepatitis C Foundation Handout Abnormal liver function tests do suggest chronic disease, but there is no correlation between liver function tests and the severity of the disease. A liver biopsy is the BEST way to tell what damage has been done to your liver because of the hepatitis virus. Liver damage can occur in symptomatic as well as asymptomatic patients. Damaged liver cells will impair the function of the liver. THE BIOPSY A liver biopsy is a diagnostic procedure that is used to obtain a small amount of liver tissue. It will then be examined under a microscope by a pathologist to determine if any liver damage has occured. The liver biopsy will indicate if the liver is scarred (scar tissue is beginning to replace functioning liver cells), if inflammation (cellular infiltration and swelling) is present, or if necrosis (dead liver cells) are present. When the liver becomes permanently injured the condition is called cirrhosis. How is it performed? A liver biopsy is performed by a specialist at the hospital. Some hospitals keep you overnight while others keep you for up to eight hours. It all depends on where you are having yours done. Both ways are acceptable. Your physician will determine the best location on your liver for this tissue to be taken. You will lie down on your side with your right hand under your head. You will be told to remain as still as possible during the procedure. The location will be cleaned with an antiseptic. The physician will insert a needle full of anesthetic to numb the area. You may feel mild pain as a result of the anesthetic. When the area is completely numb the the specialist will insert the biopsy needle into your liver, taking a piece. You may experience some pain when the needle is inserted. You will be told to hold your breathe while the needle is in your body. The needle is then taken out after about one second. You will be told to breathe normally. A bandage will be placed over the biopsy site. Your vital signs will be closely monitored while in the hospital. You will remain on your right side for several hours to help stop bleeding. You may experience pain for several hours following this procedure. Ask for pain medication if needed. You should rest for the next 24 hours. Possible complications: Possible complications from the biopsy include tenderness, rigidity and bleeding a the biopsy site. Be alert for symptoms of a collapsed lung, such as labored breathing or persistent shoulder or chest pain. You should notify your doctor immediately if you are experiencing any of the above. Risks: There are minimal risks involved when having a biopsy. The primary risk involved is bleeding from the biopsy site. This only occurs in 1% of patients. Other risks may include puncturing of other internal organs. This rarely occurs. The risk of death from a liver biopsy is less than .1%. A BIOPSY SHOULD NOT BE DONE IF YOU HAVE TAKEN ASPIRIN PRODUCT 5-7 DAYS PRIOR TO PROCEDURE. A BIOPSY SHOULD NOT BE DONE IF YOUR HEMOGLOBIN IS BELOW 9-10 GRAMS/dl. A BIOPSY SHOULD NOT BE DONE IF YOUR PROTHROMBIN TIME INR IS ABOVE 1.4. A BIOPSY SHOULD NOT BE DONE ON PATIENTS WITH BLEEDING DISORDERS UNLESS THEY ARE TRANSFUSE WITH CLOTTING FACTOR PRIOR TO THE BIOPSY. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Source: Teaching Patients With Chronic Conditions Springhouse Corp, Springhouse, Penn, 1992 PREPARING FOR A LIVER BIOPSY Patient-Teaching Aid BEFORE THE TEST: * Don't eat or drink anything 4 to 8 hours before the test, or as your doctor orders. * Expect to have a blood test to measure your blood's clotting ability and other factors. * Just before the test, be sure to empty your bladder. THE PROCEDURE * During the test, you will lie on your back with your right hand under your head. You will need to remain in this position and keep as still as you can. The doctor will drape and cleanse the area on your abdomen. He will then inject a local anesthetic, which may sting and and cause brief discomfort. * When you are told, hold your breath and lie still as possible as the doctor inserts the biopsy needle into the liver. Be assured that the needle will remain in your liver for only about 1 second. The needle may cause a sensation of pressure and some discomfort in your right upper back. * After the needle is withdrawn, resume normal breathing. The doctor will apply pressure to the biopsy site to stop any bleeding. Then he will apply a pressure bandage. AFTER THE TEST * You will be told to lie on your right side for 2 hours, with a small pillow tucked under your side. For the next 24 hours, you should rest in bed. Your vital signs will be checked periodically. * Tell your doctor or nurse right away if you experience any problems, including chest pain, persistent shoulder pain, or difficulty breathing. * You can resume your normal diet. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Note From Candi: Information gathered from past members have reported that some doctors will perform a liver biopsy without the use of anesthetic, while others use it. Some doctors will use a scoping devise/Ultrasound to help guide the biopsy needle. Some biopsy patients report no pain, some with mild pain or pressure, and others experience much discomfort during and after. ALL BIOPSYS ARE NOT THE SAME! (Even different biopsys done on the same patient!) Best advise is to discuss the biopsy procedure with your doctor BEFORE the procedure. Ask about the different options offered. Bring in a list of questions for your doctor-or just copy this paper, and bring it in to help you discuss your biopsy. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ INTERPRETING BIOPSY RESULTS Book Source: "Living With Hepatitis C"-A Survivor's Guide Dr. T. Everson, MD & Hedy Weinberg Hatherleigh Press, New York, 1998 *STAGE I- is characterized by inflammation without the development of any scar tissue. *STATE II- features include inflammation with early scarring (fibrosis) in one zone (portal) of the liver. *STATE III- shows bridging the fibrosis between adjacent portal tracts. *STATE IV- is cirrhosis (advanced scarring with loss of normal liver architecture. Later Warning Signs of Cirrhosis What does cirrhosis mean? Cirrhosis simply means the hardening of the liver due to a buildup of scar tissue. Patients who have early-stage cirrhosis may not have any symptoms. Late stage cirrhosis is characterized by complications (some of which are life threatening) and limited survival. Patients with any or all of the following signs may be potential candidates for a liver transplant: * Yellowing of the skin and whites of the eyes: jaundice. * Fluid buildup: ascites. * Bleeding: variceal hemorrhage. * Mental confusion: portal-systemic encephalopathy. * Weight loss. * Thinning of bones (osteoporosis) and fractures: metabolic bone diseases. * Blood clotting problems: coagulopathy. * Itching: pruritus. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 What the heck is a PCR? Polymerase chain reaction (PCR) is a technique which is used to amplify the number of copies of a specific region of DNA, in order to produce enough DNA to be adequately tested. This technique can be used to identify with a very high-probability, disease-causing viruses and/or bacteria, a deceased person, or a criminal suspect. In order to use PCR, one must already know the exact sequences which flank (lie on either side of) both ends of a given region of interest in DNA (may be a gene or any sequence). One need not know the DNA sequence in-between. The building-block sequences (nucleotide sequences) of many of the genes and flanking regions of genes of many different organisms are known. We also know that the DNA of different organisms is different (while some genes may be the same, or very similar among organisms, there will always be genes whose DNA sequences differ among different organisms - otherwise, would be the same organism (e.g., same virus, same bacterium, an identical twin; therefore, by identifying the genes which are different, and therefore unique, one can use this information to identify an organism). A gene's building-block sequence is the precise order of appearance, one after the other, of 4 different components (deoxyribonucleotides) within a stretch of DNA (deoxyribonucleic acid). The 4 components are: Adenine, Thymidine, Cytosine and Guanine, abbreviated as: A, T, C and G, respectively (a 4-letter alphabet). The arrangement of the letters (one after the other) of this 4-letter alphabet generates a "sentence" (a gene sequence). The number of letters in the sentence may be relatively few, or relatively many, depending on the gene. If the sentence is 1000 letters-long, the sequence would be said to be 1 kilobase (1000 bases). As an example: ATATCGGGTTAACCCCGGTATGTACGCTA would represent part of one gene. DNA is double-stranded (except in some viruses), and the two strands pair with one another in a very precise way. EACH letter in a strand will pair with only one kind of letter across from it in the opposing strand: A ALWAYS pairs with T; and, C ALWAYS pairs with G across the two strands. So: TTAACGGGGCCCTTTAAA........TTTAAACCCGGGTTT Would pair with: AATTGCCCCGGGAAATTT........AAATTTGGGCCCAAA Now, let's say that the above sequences "flank" (are on either end of..) the gene, which includes a long stretch of letters designated as: .............. These are known, absolutely identified to be, the sequence of letters which ONLY flank a particular region of a particular organism's DNA, and NO OTHER ORGANISM'S DNA. This region would be a target sequence for PCR. The first step for PCR would be to synthesize "primers" of about 20 letters-long, using each of the 4 letters, and a machine which can link the letters together in the order desired - this step is easily done, by adding one letter-at-a-time to the machine (DNA synthesizer). In this example, the primers we wish to make will be exactly the same as the flanking sequences shown above. We make ONE primer exactly like the lower left-hand sequence, and ONE primer exactly like the upper right-hand sequence, to generate: TTAACGGGGCCCTTTAAA........TTTAAACCCGGGTTTAATTGCCCCGGGAAATTT...... and: ............TTTAAACCCGGGTTTAATTGCCCCGGGAAATTT........AAATTTGGGCCCAAA Now. the ........ may be a very long set of letters in-between; doesn't matter. If you look at this arrangement, you can see that if the lower left-hand primer sequence (italics) paired to the upper strand could be extended to the right in the direction of the arrow, and the upper right-hand sequence paired to the lower strand could be extended to the left in the direction of the arrow (remembering that the ......... also represent letters, and opposite pairing will ALWAYS be A to T and C to G), one could successfully exactly duplicate the original gene's entire sequence. Now there would be four strands, where originally there were only two. If one leaves everything in there, and repeats the procedure, now there will be eight strands, do again - now 16, etc.. therefore, about 20 cycles will theoretically produce approximately one-million copies of the original sequences (2 raised to the 20th power). Thus, with this amplification potential, there is enough DNA in one-tenth of one-millionth of a liter (0.1 microliter) of human saliva (contains a small number of shed epithelial cells), to use the PCR system to identify a genetic sequence as having come from a human being! Consequently, only a very tiny amount of an organism's DNA need be available originally. Enough DNA is present in an insect trapped within 80 million year-old amber (fossilized pine resin) to amplify by this technique! Scientists have used primers which represent present-day insect's DNA, to do these amplifications. Here is how PCR is performed: First step: unknown DNA is heated, which causes the paired strands to separate (single strands now accessible to primers). Second step: add large excess of primers relative to the amount of DNA being amplified, and cool the reaction mixture to allow double-strands to form again (because of the large excess of primers, the two strands will always bind to the primers, instead of with each other). Third step: to a mixture of all 4 individual letters (deoxyribonucleotides), add an enzyme which can "read" the opposing strand's "sentence" and extend the primer's "sentence" by "hooking" letters together in the order in which they pair across from one another - A:T and C:G. This particular enzyme is called a DNA polymerase (because makes DNA polymers). One such enzyme used in PCR is called Taq polymerase (originally isolated from a bacterium that can live in hot springs - therefore, can withstand the high temperature necessary for DNA-strand separation, and can be left in the reaction). Now, we have the enzyme synthesizing new DNA in opposite directions - BUT ONLY THIS PARTICULAR REGION OF DNA. After one cycle, add more primers, add 4-letter mixture, and repeat the cycle. The primers will bind to the "old" sequences as well as to the newly-synthesized sequences. The enzyme will again extend primer sentences .... Finally, there will be PLENTY of DNA - and ALL OF IT will be copies of just this particular region. Therefore, by using different primers which represent flanking regions of different genes of various organisms in SEPARATE experiments, one can determine if in fact, any DNA has been amplified. If it has not, then the primers did not bind to the DNA of the sample, and it is therefore highly unlikely that the DNA of an organism which a given set of primers represents, is present. On the other hand, appearance of DNA by PCR will allow precise identification of the source of the amplified material. Copyright C. Brown, 1995 ======== http://village.vossnet.co.uk/c/crina/pag-tests-PCR.html PCR - Polymerase Chain Reaction. Is the most accurate test available at present. It involves the amplification of the nucleic acid associated with the virus several million times, by using the "chain reaction", in order to bring it up to measurable levels. As the amplification process is fully controlled, the quantity of original material present in the sample (the viral load) can be calculated with a great degree of accuracy. bDNA - Also tests for the presence of the virus in the blood, but is less sensitive than the PCR test, picking up only levels over 200,000 virus equivalents/ml. Viral Load (by Albrecht Ernst ) I.) What is Viral Load ? Your viral load is the amount of viruses present in a given volume of your blood (usually 1 millilitre = 1 cubic centimeter). More precisely, it means that the amount of hepC genetic material found in your blood corresponds to as many hep C viruses as the given number says. Therefore the given number denotes 'viral equivalents'. II.) "Not detected" The viral load can range from "not detected" to hundreds of millions. The meaning of "not detected" or "negative" differs, depending on the test used. In my lab, the detection limit for the "quantitative" HCV RNA test by "PCR" is 200 virus equivalents/ml (and with the "qualitative" test they can detect down 100 virus equivalents/ml ). The less expensive quantitative "bDNA" test has a detection limit of about 200,000 virus equivalents/ml, which makes it less sensitive, but above its detection limit it is more accurate than the PCR test. So, when you are "negative", maybe you have no hepatitis C virus in your blood. But maybe also, you do have hepatitis C virus in your blood, but the number of viruses is lower than the detection limit. III.) "Positive" - What's important to note, besides the pure numbers When you get back the result of your HCV RNA quantitative test, and when the lab was able to determine the amount of virus in your blood, then it is important to write down not only the number, but also in what units this number is given. A) Volume The volume of blood that the number refers to is usually one millilitre. But some labs give the number for 20 microlitres = 1/50 millilitre. So in these cases you have to multiply the result of the viral load by 50 to get the number for 1 millilitre. Amount of Virus Unfortunately, there are several ways to express the viral load. So, in order to be able to compare different results, you have to know how to convert these numbers to some standard format, which I would say is just the plain number of viruses per millilitre, like 1.5 Million/ml, or 1,500,000/ml. 1.) By weight Sometimes, the lab reports the amount of genetic material found by its weight. 1 pg (pico-gram) of genetic material corresponds to about 1 million virus equivalents, so, if your lab result is given in picograms, just multiply the lab result by 1,000,000, and you have the number of viruses. 2.) By virus count a.) Plain numbers Often the virus count is expressed as a plain number, like 1.73 million, or 1,730,000 or 1730000. Millions sometime are abbreviated by the prefix "M" (Mega). So when you see 1.73 Meq/ml, it means 1.73 Mega-equivalents/ml or again 1730000 equivalents/ml. b.) Exponential format Large numbers are often expressed in exponential form, that means a number, multiplied by 10 with an exponent. To convert this to normal numbers, append as many zeroes to a "1" as the exponent says, and multiply this with the number. In some lab report, the viral load was "Hep C RNA Quant 17.3 x 10(exp) 5 equivalents/ml". So, with 5 as exponent, you have to append 5 zeroes to an "1", that gives 100000, and multiply this with the number 17.3, that gives 1730000 as the viral load. Normally this would be written 1.73x10(exp)6, or 1.73x106 , which are the same number. At the same time, 17.3x105 = 1.73x106 = 1,730,000 c.) Logarithmic format Now, recently some people express these numbers also in logarithmic form (logarithmic transformed number). log(1730000)=6.24 6.24 is the logarithmic transformed number of the viral load of our above example. A result of 3.5 for a viral load, that someone reported, seems to be such a number (unless he forgot to write down a "10" and an exponent). You need a calculator to convert this. You have to use the function 10x, where you have to replace x with the logarithmic number, in the above case 3.5. The result would be 103.5 = 3162 virus equivalents per milliliter. When you take the logarithmic number from the first example, 6.24, you have to calculate 106.24 = 1730000 , and here we have the original number of virus equivalents again. If you don't have a calculator, you can estimate the order of magnitude of a viral load expressed as a logarithmic number. From the logarithmic number, you take the first digit (to the left of the point ) and add 1 to this number. This gives you the number of digits that your viral load has (expresses as a plain number). Example: Logarithmic number 6.24 Left of the point is "6". 6+1 = 7 The number that gives the viral load is 7 digits long, that means it is between 1,000,000 and 9,999,999 (digit # 1 234 567). The next digit ( right of the point of the logarithmic number ) shows whether you are high or low in the range. In case ( but I have never seen that ) you have a logarithmic number and a blood volume other than 1 ml, you have to convert the logarithmic number to a plain number *first*, and then correct it to correspond to 1 ml ! Therefore it is important to have a close look at your lab report and see in what units the result is given ! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2004 Report Share Posted January 20, 2004 -You absolutely MUST have a quantitative ( quant ) PCR done prior to beginning any treatment. This is a test that measures the amount of virus in your blood down to a certain level depending on the sensitivity of the test. If your viral load is high - over 2.5 copies/mL - a stronger initial treatment is recommended. There's no sense going through a basic treatment if you're at decreased odds of it working and it can later hurt the chances of a stronger therapy working. Studies show that a large initial decrease in viral load is a good indicator that treatment will succeed, so some docs will run another quant PCR shortly after beginning treatment. You must recieve a quant PCR every 3 mos throughout treatment however. Most likely you've had a qualitative PCR, which measures whether or not the virus is present in your blood down to a certain level depending on the sensitivity of the test. These are usually used to positively identify that the virus is present ( which you've already had ) and then towards the end of therapy and afterwards at your 3 month check ups. ========== Unfortunately that is not the way it works. Viral Loads are interpreted in their logarythim basis. If your changed from 750,000 to 250,000 it still remained as log 5, in other words , there was no change in VL at all. It would have changed if VL would go down from 750,000 to say 75,000 or log 4. You must understand that PCR is a very unreliable type of blood test. Anything can interfere with it and the series of multiplications they do from one step to the other amplifies any little error. This is why it varies a great deal and has to be interpreted only relative to a log number. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2004 Report Share Posted January 21, 2004 Thank you for taking the time to find us some good info. I know I read much of this data before, but my retention isn't that great. It's good for a refresher now and then. I drove my dr crazy by all my research on the internet, he was a little doubtful of it's accuracy. It's true you have to be careful of your sources, because anybody can post whatever they want on the net, but you seem to have found some pretty reliable sources. -dz-Angls4Hope@... wrote: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2004 Report Share Posted January 21, 2004 I agree with the test. It's a good barometer. I'm not sure if it's my HMO or just my dr, but he waited 6 mos to take the 2nd PCR test and it was negative. I have heard that others have had tests done at 3 mos as well. I understand it's a very expensive test, so I'm suspicious of my HMO limiting me to the test at 6 mos. I also had a limited test which would only measure up to 1,000,000 and I only knew I was over that, but not by how much. -dz-Angls4Hope@... wrote: -You absolutely MUST have a quantitative ( quant ) PCR done prior to beginning any treatment. This is a test that measures the amount of virus in your blood down to a certain level depending on the sensitivity of the test. If your viral load is high - over 2.5 copies/mL - a stronger initial treatment is recommended. There's no sense going through a basic treatment if you're at decreased odds of it working and it can later hurt the chances of a stronger therapy working. Studies show that a large initial decrease in viral load is a good indicator that treatment will succeed, so some docs will run another quant PCR shortly after beginning treatment. You must recieve a quant PCR every 3 mos throughout treatment however. Most likely you've had a qualitative PCR, which measures whether or not the virus is present in your blood down to a certain level depending on the sensitivity of the test. These are usually used to positively identify that the virus is present ( which you've already had ) and then towards the end of therapy and afterwards at your 3 month check ups.==========Unfortunately that is not the way it works.Viral Loads are interpreted in their logarythim basis.If your changed from 750,000 to 250,000 it still remainedas log 5, in other words , there was no change in VL at all.It would have changed if VL would go down from 750,000to say 75,000 or log 4.You must understand that PCR is a very unreliable type ofblood test. Anything can interfere with it and the series ofmultiplicationsthey do from one step to the other amplifies any little error.This is why it varies a great deal and has to be interpreted only relative to a log number. Quote Link to comment Share on other sites More sharing options...
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