Since October 2012 I have had elevated total bilirubin levels (3.3, 3.9, 4.2, 2.9, 5.0). My last blood test which was done on 2/19/13 showed the total bilirubin to be 5. I had two biopsies done. The first biopsy was done in August 2011 and was read differently by two pathologists with different results. The first pathologist reading showed grade 1 inflammation stage 0 fibrosis. The second pathologist reading who viewed those same slides stated that the biopsy showed grade 2 of 4, stage 2 of 4 with positive autoimmune markers. My blood work ANA marker came back positive and the rest of the markers came back negative.
I had a second biopsy done in Dec 2012 which stated moderate activity grade 3 of 4, stage 2-3 of 4 with no autoimmune features detected. My hepatologist said that bilirubin does not fluctuate with HCV and wants me to do another biopsy. She believes there is an autoimmune condition. I take cholestyramine when the itching becomes severe. I asked her if cholestyramine could lower bilirubin she said no and on another visit she said yes. I do not believe I have autoimmune hepatitis as the blood work and biopsy did not show it and refused to do a third biopsy. I also had a CT and MRI scan which ruled out any gallstones or billary obstruction. I believe it is just HCV causing the elevation in bilirubin. I have been trying to find out what is going on with me since October 2012 with no answers. What is your opinion on this?
HCV should not cause an eleavted bilirubin in the absence of cirrhosis unless you have an overlap syndrome with autoimmune hepatitis. Instead of getting a 3rd biopsy it might be worth getting an expert liver pathologist to read the slides. i would recommend dr isabel fiel here at Mount sinai.
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