Question Title: Consequences of cryoglobulinemia?

Forum: The Hepatitis Forum
Topic: Hepatitis C

First thankyou for taking the time to read this. Here is my biopsy results from two years ago. I will let you read that because that is what my questions are going to be based on.

Surgical Pathology Tucson Medical Center

Clinical information received Specimen

Hepatitis C Liver biopsy

Gross:

The specimen consists of four fragments of tan-brown cylindrical tissue measuring 8mm in length. Tp/kg

MICRO:

Step sections of the liver biopsy demonstrate distortion of the normal hepatic architecture. There is a marked portal chronic inflammatory cell infiltrate and fibrosis with mild piecemeal necrosis. The hepatocytes demonstrate diffuse mild fatty metamorphosis and focal collections of lymphocytes within the lobules. A trichrome stain demonstrates focal bridging fibrosis/cirrhosis.

Diagnosis: Liver core biopsies: Chronic hepatitis with mild activity and cirrhosis.

My doctor told me that this was considered early cirrhosis. Then he checked my ammonia levels and they are high. He then said I have hepatic encephalopathy. I also have tested postive for cryoglobulinemia. I have 3% cryo reading in my blood. I have vasculitis in my lower legs and suffer from very poor circulation. I am also just in the last couple of months starting to experience numbness in my arms and legs and feet. With all of this said...

1. Is the fact that I have hepatic encephalopathy put me in the end stage liver failure category?
2. Is it recommended that I go for treatment? It's my understanding that having the ammonia levels contraindicates treatment.
3. What are the disease consequenses of cryoglobulinemia. What is the treatment for this?
4. I have spider viens all over my chest and my back. What is the signifance of these?
5. Should I be scoped for varices at this time? Or should I wait until I have a bleed?

I will be going to the doctor in June and pursueing what my options are and getting a prescription for Lactulose. I appreciate any information you can share with me about all of this and sorry it is so long.
Thanks once again for your time.
Kendall

Dear Kendall:

I really appreciate your letter as well as how difficult your situation must be. I’d like to try to make some general comments to help.

You have to appreciate that there is considerable complexity to your situation and it is difficult to give specific information in such a situation. You have cryoglobulinemia and vasculitis. In addition, you have advanced disease with cirrhosis on biopsy, multiple spider angiomata and a question of hepatic encephalopathy. This is a situation, where you need an experienced liver specialist who can look at a variety of factors to decide how advanced your liver disease is, whether you are a candidate for treatment for you hepatitis C and whether you should be considered for liver transplant. I would like to make a few comments, however.

First and foremost, a high serum ammonia level alone does not give you the diagnosis of hepatic encephalopathy. We really need to see some impairment in thinking or in psycho-motor skills. These changes can be subtle but the ammonia alone does not give you the diagnosis. I am a liver specialist at an active transplant program and I rarely obtain a serum ammonia level. As a result, I am not in a position to tell you that you have a failing liver based on your high serum ammonia level. The decision to treat patients with hepatitis C with advanced disease is always a little complicated. While the disease is clearly advancing and you would like to try some treatment, patients with advanced disease are less likely to be cured and have more potential for adverse effects from the drugs.

Cryoglobulins are a special type of antibody your body makes that are seen in patients with hepatitis C that can be associated with vasculitis, kidney disease and joint pain. Symptoms of cyroglobulinemia often respond well to interferon but it is difficult to eradicate the hepatitis C virus in people with cryoglobulinemia and the symptoms often flare back up when the interferon is stopped. We don’t have as much experience with combination therapy (interferon with ribavirin) but we hope that this might give more durable responses.

Your final question about endoscopy and esophageal varices is not entirely straightforward. It’s really going to depend upon a good evaluation to determine the extent of your liver disease. I stress that that is the most critical thing for you right now. You need a complete and comprehensive evaluation by someone with a lot of experience with hepatitis C and advanced liver disease.

I hope this information is helpful to you. If you have additional questions or concerns, I invite you to post them through MedHelp. The direct number to our Liver Clinic is (313) 916-8865. We have an active group of liver specialists with an interest in the care and research of hepatitis C.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

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