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Liver biopsy in Irish hepatitis C-infected patients with inherited bleeding disorders
C McMahon1, R Pilkington, E O Shea
1National Centre for Inherited Bleeding Disorders and Department of Gastroenterology, St James's Hospital, Dublin 8, Ireland.
Insights
Liver biopsy is safe for patients with bleeding disorders and hepatitis C. Correcting clotting factors ensures hemostasis, allowing accurate staging of liver fibrosis for prognosis.
Area of Science:
- Hepatology
- Hematology
- Virology
Background:
- Many patients treated with clotting factors from the 1970s-1980s contracted hepatitis C.
- Hepatitis C progression varies, with poor correlation between liver tests, viral load, and disease stage.
- Liver biopsy is the gold standard for staging liver fibrosis and necroinflammation.
Purpose of the Study:
- To evaluate the safety and efficacy of liver biopsy in patients with inherited bleeding disorders and hepatitis C.
- To determine if liver biopsy can accurately stage liver disease in this patient population.
Main Methods:
- 21 liver biopsies were performed between 1984-1997 on patients with Factor VIII (FVIII) deficiency, Factor IX (FIX) deficiency, or von Willebrand's Disease (VWD).
- Coagulopathy was corrected using factor concentrates or continuous infusion; one patient received Desmopressin (DDAVP).
- Patients included those with concomitant human immunodeficiency virus (HIV) infection, thrombocytopenia, or prolonged prothrombin time (PT).
Main Results:
- No bleeding complications occurred post-biopsy in any of the 21 patients.
- Effective hemostasis was maintained throughout the peribiopsy period with modern correction regimens.
Conclusions:
- Liver biopsy is a safe and definitive procedure for staging hepatitis C-related liver fibrosis in patients with inherited bleeding disorders.
- Accurate staging of liver fibrosis is crucial for determining prognosis in these patients.
Abstract:
The majority of patients receiving plasma-derived clotting factor concentrates between 1970s and the mid-1980s are now hepatitis C positive. The progression of hepatitis C is extremely variable and there is frequently a poor correlation among liver biochemistry, viral load and the stage of liver disease. Liver biopsy remains the only definitive way of staging fibrosis and grading necroinflammatory activity. Concerns have been expressed about the safety of the procedure; however, with modern regimes for the correction of coagulopathy in patients with inherited bleeding disorders, normal haemostasis may be maintained during the peribiopsy period. We performed 21 liver biopsies between 1984 and 1997 on patients with factor VIII (FVIII) or IX (FIX) deficiency and von Willebrand's Disease (VWD). Four had concomitant human immunodeficiency virus (HIV) infection, five were thrombocytopenic and one had a prolonged prothrombin time (PT). Haemostasis was achieved using an intermittent bolus of factor concentrate or continuous infusion regimens. One patient with VWD received Desmopressin (DDAVP). There were no bleeding episodes associated with biopsy. We suggest that liver biopsy is a safe procedure in patients with inherited bleeding disorders when the coagulopathy is fully corrected. It is the only definitive method of staging the extent of fibrosis associated with hepatitis C infection, and it is this that defines prognosis.