Effect of antiviral therapy on hematological parameters in patients with chronic hepatitis

To find out the effect of antiviral therapy on hematological parameters in patients of chronic hepatitis. Interventional descriptive study. Military hospital [MH] Rawalpindi Pakistan from May to Oct 2004. 31 patients admitted to M.H Rawalpindi for treatment of chronic hepatitis were studied. Their hematological parameters including Total Leucocyte count [TLC], Haemoglobin [Hb] and Platelet count [Plt] were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given Inj Alpha-Interferon [INF] and Tab Ribavirin as antiviral therapy. Data was collected over a period of 6 months. Descriptive statistics were applied to the recorded data using SPSS ver-10.0 for analysis. 31 patients with mean age +/- SD 38.58 +/- 8.85 years [range 16-49 years] were studied. There was mean hemoglobin [Hb] fall of 0.87g/dl at 3 months and 2g/dl at 6 months of antiviral therapy. Mean Total leukocyte count [TLC] fall of 1.30x10[9]/L at 3 months and 1.87x109/L was noted at 6 months. Similar downward trend was noted in Platelet [Plt] values with mean fall of 23.19x10[9]/mm[3] and 28.29/ mm[3] at 3 and 6 months of antiviral therapy respectively. 10% of the cases developed clinically significant anemia as evidenced by hemoglobin 11g/dl after 6 months of antiviral therapy. Clinically significant leucopenia [< 2.5x10[9]/l] was noted in 7% of the cases. This fall was noted only in first three months of treatment. There is significant decrimental response of hematological parameters to antiviral therapy

Alpha-L-fucosidase as a serum marker of hepatocellular carcinoma in Thailand.

To evaluate the role of serum alpha-L-fucosidase (AFU) in the diagnosis of hepatocellular carcinoma (HCC), we simultaneously studied both AFU activity and alpha-fetoprotein (AFP) level in 60 patients with HCC, 60 patients with cirrhosis and chronic hepatitis each, 30 patients with other liver tumors and 60 healthy subjects. Serum AFU activity in patients with HCC (1,418.62 +/- 575.76 nmol/ml/hr) was significantly higher than that found in cirrhosis (831.25 +/- 261.13 nmol/ml/hr), chronic hepatitis (717.71 +/- 205.86 nmol/ ml/hr) or other tumors (706.68 +/- 197.67 nmol/ml/hr) and in controls (504.18 +/- 121.88 nmol/ml/hr, p < 0.05). With 870 nmol/ml/hr (mean value of controls plus 3 standard deviations) considered as the cut-off point, AFU was more sensitive (81.7 vs 39.1%) but less specific (70.7 vs 99.3%) than AFP at a level of > 400 ng/ml as a tumor marker of HCC. With both markers combined, the sensitivity was improved to as much as 82.6%. AFU activity in HCC patients was correlated to tumor size (r = 0.3529, p = 0.006) but not associated with tumor staging classified by Okuda's criteria (p = 0.1). The AFU activity in the viral hepatitis group (hepatitis B or C) was also significantly higher than in the non-viral group (p = 0.0005). We conclude AFU to be a useful marker, in conjunction with AFP and ultrasonography, for detecting HCC, particularly in patients with underlying viral hepatitis and cirrhosis.

Acute exacerbation in chronic hepatitis B virus infection

A case of an acute exacerbation of liver injury in a chronic HBV infected young male is reported. The correlation between the severe symptomatic hepatitis is done with the histopathologic findings of extense areas of bridging necrosis on the liver biopsy. The serological pattern for markers of HBV (Bhs Ag +, anti Hbs -, HBeAg -,antiHBe +, anti Hbc IgG + and IgM -) confirm a chronic infection, and the authors propose that the episode of severe hepatitis relates to the recent spontaneous seroconvertion of HbeAg to anti Hbe. Other causes of hepatitis were excluded, and the control liver biopsy (6 months later) showed normalization of hepatic architecture and absence of markers of viral replication in tissue and serum. A review of literature is done in an attempt do elucidate the diagnostic possibilities in this cases, with emphasis on new immunoassays useful in differentiating between acute hepatitis B and acute exacerbation of a chronic hepatitis by the same virus.

Sistema Age HB/Anti-e HB en niños con hepatitis crónica activa / Hbe Ag/anti-Hbe system in children with chronic active hepatitis

En el presente trabajo se determinó el antígeno e del virus productor de la hepatitis B (AgeHB) y su anticuerpo (anti-eHB) en 31 niños menores de 15 años y de ambos sexos, con hepatitis crónica activa (HCA) atendidos en nuestro centro. Se encontró un alto porcentaje de AgeHB positivo (67,7 %) en la totalidad de los pacientes, mientras que los pacientes anti-eHB positivos representaron un porcentaje mucho menor (25,8 %). Los títulos de AgsHB se comportaron con promedios de 1:16 en la mayoría de los pacientes. El estudio realizado muestra una tendencia a la seroconversión del AgeHB en los pacientes con mayor tiempo de evolución

Concentración sérica de alfa-1-antitripsina en diversas enfermedades hepáticas / Serum concentration of alpha-1-antitrypsin in different hepatic diseases

Se investigó la concentración sérica de alfa-1-antitripsina (A1AT) en 195 pacientes con diversas hepatopatías y en 43 adultos sanos. En todas las enfermedades hepáticas estudiadas se encontró un incremento significativo de la A1AT sérica respecto al grupo control (p < 0,001; hepatitis fulminante p < 0,05) confirmando que esta glicoproteína es un reactante de fase aguda. En las hepatitis fulminantes la concentración sérica de A1AT fue similar a la encontrada en los pacientes con hepatitis viral aguda sin insuficiencia hepática. La mayor elevación de la A1AT correspondió a los pacientes con obstrucción biliar y tumores hepáticos (primitivos y metastásicos) registrándose diferencias significativas respecto a las hepatopatías agudas y crónicas necrótico-inflamatorias (hepatitis, cirrosis, alcoholismo) (p < 0,001); a su vez en los pacientes con hígado metastásico la A1AT sérica fue mayor que en el resto de la población estudiada (p < 0,004 vs obstrucción biliar; p < 0,05 vs hepatoma). El 96% de las metástasis hepáticas presentaron valores de A1AT mayores de 400mg% registrándose diferencias significativas con el resto del grupo. La determinación de la A1AT sérica puede ser de utilidad para el diagnóstico de los tumores hepáticos malignos; de acuerdo a nuestros hallazgos el dosaje de esta glicoproteína carece de valor en el diagnóstico del hepatocarcinoma y en la insuficiencia hepática aguda

Alteraciones de la coagulación en las hepatitis crónicas / Coagulation disorders in chronic hepatitis

Se estudian 28 pacientes que presentan hepatitis crónica, 16 de la forma agresiva y 12 de la forma persistente, desde el punto de vista de la coagulación. Se realiza una comparación con la literatura existente en nuestro medio. Se comprueba que los factores Vit K dependiente son los más alterados y que la alteración del factor V es de mal pronóstico