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Please Help me interpret
On Dec. 3/07 I had an appointment with my specialist doctor (MD, FRCPC) regarding my recently diagnosed chronic hepatitis C infection. She is putting me on 48 week course of pegylated interferon and ribavirin. She says there is no need for a liver biopsy as I have cirrhosis. Treatment will start in approximately 4 months at which time I will be covered under a health plan.My family doctor called me into discuss the results of the blood tests I underwent. He really doesn't know much about HCV so I would like some comments from the members of this forum who know more about this viral infection than my family doctor. Here are some of the test results:
-Confirmed anti-HCV and HCV RNA positive
-genotype 1b infection
-macrocytosis with an MCV of 101 and hemoglobin 149
-white count low at 3.8 and platelets low at 90
-ferritin is elevated at 650 but with a saturation of 37%.
-TSH and creatinine are normal
-no proteinuria
-liver function is with a billrubin of 11, albumin of 42 and INR 1.1
-liver enzymes are moderately elevated with an ALT of 166 and AST of 113
-alpha fetoprotein is elevated at 23
- ultrasound indicates there is splenule at the level of the splenic hilum otherwise unremarkable with no hepatobiliary abnormalty.
I most likely will not see this specialist for quite some time and I don't know how bad off I am. I wonder with cirrrhosis how much time I have left before liver failure. Sometimes it is hard to be positive with this bleak of a diagnosis. Any information would help me. Thanks in advance. Don
-Confirmed anti-HCV and HCV RNA positive
-genotype 1b infection
-macrocytosis with an MCV of 101 and hemoglobin 149
-white count low at 3.8 and platelets low at 90
-ferritin is elevated at 650 but with a saturation of 37%.
-TSH and creatinine are normal
-no proteinuria
-liver function is with a billrubin of 11, albumin of 42 and INR 1.1
-liver enzymes are moderately elevated with an ALT of 166 and AST of 113
-alpha fetoprotein is elevated at 23
- ultrasound indicates there is splenule at the level of the splenic hilum otherwise unremarkable with no hepatobiliary abnormalty.
I most likely will not see this specialist for quite some time and I don't know how bad off I am. I wonder with cirrrhosis how much time I have left before liver failure. Sometimes it is hard to be positive with this bleak of a diagnosis. Any information would help me. Thanks in advance. Don
Like I said -- try and find out what criteria they used to diagnosis you with cirrhosis. The diagnosis is a critical part of the whole process, and if you're unclear/unsure, then get it resolved. And make sure you're seeing a "hepatologist" -- not a "GI", not any other type of doctor.
-- Jim
-- Jim
Jim, Thanks for the reply and all of the information. My abdominal examination revealed dullness to percussion over Castell's point (???) consistent with mild splenomegaly although the spleen tip is not palpable. (??) Liver edge is firm and non tender. There is no evidence of ascites and no peripheral edema. (???). On Jan. 21/08 I am booked for a gastroscopy in January.
Another factor that is not in my favor is my age. I will be 62 next month. What are my odds of living another 10 years? I wish I knew.
Another factor that is not in my favor is my age. I will be 62 next month. What are my odds of living another 10 years? I wish I knew.
Good luck w/treatment, I hope it helps improve your situation. I'm curious about your AFP reading; is that in I.U. or nanograms?
I did just notice that you have had an ultrasound. Was there any mention of ascites?
In addition to confirming your cirrhosis and phlebotomy, a few other things to discuss with your specialist:
(1) Extending treatment beyond 48 weeks because of your cirrhosis, especially if you do not have an RVR (UND at week 4).
(2) Early and sensitive viral load testing starting at week 4 of treatment or earlier.
(3) Will they intervene early with helper drugs such as Procrit (epo) if necessary, as opposed to dropping your dosage.
Again, better to have these discussions and questions answered well in advance of treatment.
Meanwhile, try and obtain and organize every test (blood, ultrasound reports, etc) you have been given, and continue to get copies of all tests and procedures from here on out.
All the best,
-- Jim
(1) Extending treatment beyond 48 weeks because of your cirrhosis, especially if you do not have an RVR (UND at week 4).
(2) Early and sensitive viral load testing starting at week 4 of treatment or earlier.
(3) Will they intervene early with helper drugs such as Procrit (epo) if necessary, as opposed to dropping your dosage.
Again, better to have these discussions and questions answered well in advance of treatment.
Meanwhile, try and obtain and organize every test (blood, ultrasound reports, etc) you have been given, and continue to get copies of all tests and procedures from here on out.
All the best,
-- Jim
Cirrhosis can often be predicted without biopsy, but if it were me, I'd ask my doctor specifically how the diagnosis was made. Since he apparently doesn't know much about HCV, you might want a direct line with the doctor who made the diagnosis.
I assume you had an ultrasound where they can measure the size of your spleen as well as do some preliminary screening of liver cancer given your raised AFP? Given the totality of your situation, an MRI and even a CatScan seem reasonable at this point, especially in lieu of the biopsy.
Also, did you show ascites (fluid in abdomen) via ultrasound? And did you have an endoscophy to check for varisces (bleeding veins)? Two important tests for someone diagnosed with cirrhosis.
As a genotype 1B, assuming cirrhosis, treatment is inherently more complicated, so hopefully your specialist is a hepatologist (liver specialist) and not a Gastro. I would check this out and change to a hepatologist if you haven't been assigned one.
Lastly, some recent studies show that phlebotomy (blood letting) may increase the chance of SVR (cure) in those with too much iron. Given your elevated ferritin, something to discuss with the specialist well in advance of treatment. I would not wait until just before.
All the best,
-- Jim
I assume you had an ultrasound where they can measure the size of your spleen as well as do some preliminary screening of liver cancer given your raised AFP? Given the totality of your situation, an MRI and even a CatScan seem reasonable at this point, especially in lieu of the biopsy.
Also, did you show ascites (fluid in abdomen) via ultrasound? And did you have an endoscophy to check for varisces (bleeding veins)? Two important tests for someone diagnosed with cirrhosis.
As a genotype 1B, assuming cirrhosis, treatment is inherently more complicated, so hopefully your specialist is a hepatologist (liver specialist) and not a Gastro. I would check this out and change to a hepatologist if you haven't been assigned one.
Lastly, some recent studies show that phlebotomy (blood letting) may increase the chance of SVR (cure) in those with too much iron. Given your elevated ferritin, something to discuss with the specialist well in advance of treatment. I would not wait until just before.
All the best,
-- Jim
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