What Serologic Tests are Necessary Before a Liver Biopsy in Patients with HCV?

According to an abstract submitted by the authors to the 46th Annual Meeting of the American Association for the Study of Liver Diseases, held November 3-7, 1995, in Chicago, Illinois, "Before undergoing interferon therapy for infection with hepatitis C virus (HCV), patients usually undergo a liver biopsy and multiple serologic tests to rule out other liver diseases. In 93 HCV patients, the clinical and economic implications of omitting the serologic tests in HCV were examined.

METHODS: Over a period of two years, 93 consecutive patients entered the study. Entry criteria were elevated serum transaminases (ALT and AST), positive serum test for HCV by ELISA or RIBA, and a liver biopsy. Special stains assessed iron overload and alpha-1 antitrypsin (AI AT) deficiency. All patients had serum tests for ferritin, iron (Fe), iron binding capacity (TIBC), A1AT, ceruloplasmin, and/or anti- nuclear antibodies. The costs of each test were based on the current UNM fee schedule.

RESULTS: None of the patients showed an abnormal test for ceruloplasmin or A1AT. Five patients had a ferritin value >800 ng/ml, but only two patients also had elevated iron saturation (Fe/TIBC >65%). The two biopsies, however, did not contain increased iron and so were not consistent with hemochromatosis (HC). None of the other liver biopsies showed histopathologic changes consistent with HC, Wilson's disease, or MAT-deficiency. Testing costs were: Fe/TIBC $39.25, ferritin $61.50, ceruloplasmin $33.50, and A1AT $30. 50. The expense for these tests totalled $164.75 per person. Therefore, $15,321.75 represents the potential savings in this population of 93 patients.

CONCLUSION: If a pre-treatment liver biopsy is deemed necessary to assess liver pathology in an HCV patient, serologic testing for HC, Wilson's disease and A1AT deficiency seems redundant and not indicated, since the presence of any of these diagnoses is readily assessed by liver biopsy with special stains. The minor downside to this suggested strategy is the need send fixed tissue for iron quantitation if the iron stain is suggestive of hemochromatosis."

P.G. Quinn, D.E. Wheeler, M.M. Jamal and A. Sonnenberg.; Departments of Medicine and Pathology, University of New Mexico (UNM),; Albuquerque, New Mexico.; Blood Weekly, 12-25-1995, pp 21.

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