10742126 tn?1412449327

help understanding test results

Hi everyone,
I was diagnosed with HCV type 1a awhile ago. At that time they treated with interferon and  ribavirin (not sure about spelling) which I couldn't take because my platelets were 27,000. That's how they discovered the Hep C in fact. I gave up alcohol, ice cream, salty food, processed food, and now consume a very healthy diet. My platelets are 52,000 and my hepatologist will be treating with Harvoni as soon as insurance approves. In the meantime, the F1 fibrosis has turned into F4 cirrhosis in 2 years. I've had HCV for 35 years. Can someone help me understand the latest test results? As to what is normal levels and how relatively high mine are? I just can't wait two weeks to see him. I'm anxious to know now how bad it is!
Here are my scores:
Spleen: 19.8 diameter - I know that's twice normal size
Liver: normal size. Scarring on edges but top smooth.
Viral load: 3 million. Increase from 2 million six weeks ago.
AST: 73
ALT: 83 (I don't know what these scores mean, exactly)
Platelets: 52,000. Big jump from 27,000 six months ago!
Lipase: 0.91 which shows swelling in pancreas "but it's not cancer, don't worry very mild".
If anyone can explain normal what range is normal re: this and elaborate/explain a bit more I would be very grateful! Thank you!
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2059648 tn?1439766665
If you have questions about "Cirrhosis of the Liver" the best place to ask and get expert advice is the Medhelp "Cirrhosis of the Liver" forum.

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Avatar universal
Hi MarieLyn. I am so sorry you are dealing with this virus. I am a bit confused as you say your platelets were quite low, yet you were F1.  Low platelets are one of the first things noticed in cirrhotic (F4) patients. Either I am misunderstanding what you are saying, or perhaps your biopsy was a sampling error and you really had cirrhosis right along. The good news is that even with low platelets, you can now successfully treat because the direct acting antivirals do not cause the platelets to drop. Itis excellent the doctor is talking about treating you with harvoni or even Viekira Pak if insurance denies harvoni.

Those of us who understand how the virus works on the body know that the spleen is enlarged due to the virus causing decreased blood flow through the splenic vein.  This will cause blood to back up and cause the enlargement. When the spleen is enlarged it traps the platelets and causes them to to stay in the spleen where they can't be counted so the count is low in the blood tests. All of these things point to a cirrhotic liver. The scarring of a cirrhotic liver is also on a cellular level so just because it looks like there is scarring around the edges, that does not mean too much as far as the stage of liver disease. Your ALT and AST are indicative of inflammation which is a common finding in HCV patients. The fluctuation of the viral load is meaningless and happens all the time.

It sounds like your doc is doing all the right things and will be treating you with one of the new drugs. You will be pleased to see how much easier it is to treat than it was with interferon and ribavirin. Wishing you the very best.
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Avatar universal
You're probably aware that the elevated AST/ALT (enzymes)  is the liver's reaction (inflammation) to any number of agents.  A number of conditions and drugs will cause this as well as the HCV.  They will fluctuate and may return to normal during treatment with Harvoni and when it cures you of HCV.  Many years ago, before being Dx'd with either HCV and later cirrhosis, I was treated with the TB prophylaxis drug INH.  My enzymes when from a normal baseline to around 500 in about 4 weeks.  Stopped meds and it took about six months to normalize.

Hopefully, your doctor / insurance company is planning to treat you for 24 weeks since you're cirrhotic.  

After you cure with Harvoni you'll still need to closely monitor the cirrhosis with your hepatologist.  Many will do this surveillance with ultrasound and labs (with AFP)  every six months.  Your liver will be happy with the healthy lifestyle and diet you've adopted.

The link below is to calculate your MELD score.  This too will fluctuate. My MELD improved when I achieved SVR from Sovaldi/Olysio & Ribavirin.


You're probably already aware that the decreased platelet count (thrombocytopenia) and enlarged spleen (spleenomegaly) go hand in hand.  The below link has a little info about that.  Sorry, couldn't paste it.  Spleen size can fluctuate somewhat.  Mine is running about 15.5cm now but it has been larger and smaller. You probably benefit from eating frequent smaller meals to avoid that bloated feeling.  Portal hypertension is a factor.  Do you take a beta-blocker?


Other lab tests you'll want to keep an eye on with cirrhosis is your bilirubin, albumin, PT/PTT and creatinine for kidney function.  These give a clearer picture of how well your liver is compensating, better than the enzyme level.

Best wishes,  Marty  
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10742126 tn?1412449327
Thanks so much for responding and the link you provided! I can't stand not knowing what numbers mean, so this is really helpful and I feel much better about the whole situation! Really appreciate your informative response! :-)
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2059648 tn?1439766665
Here is a link to help you understand some of the test.  You will see the
norms of AST and ALT in the below referenced link.


F4 means you have cirrhosis of the liver.

Viral load is 3 million mean the amount of Hep C virus you have in a square centimeter of blood.  This doesn't really mean much except for adjustments
to your Hepatitis C treatment.

Your platelets are low but its good that they came up from 27,000.

I can't tell you why your spleen is enlarged.
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