Continuing the discussion from EXPLAINER: Lab results and their interpretation:
Good day Dr. Thomas i really appreciate your help, I run another test for HBV AND LFT
The results are:
HBV
Hbsag: positive
Hbsab: negative
Hbeag negative
Hbeab positive
Hbcab positive
LFT
AST: 11.I U/L (up to 12)
ALT: 5.4 U/L (up to 12)
ALB: 4 g/dl (to 3.8-4.4)
T. Protein 7.5 g/dl (64-83)
TBC: 12 mg (up to 1.7)
DBC: 2.5 Lm/L (up to 4)
The first test was conducted more than 6 months ago. Can this be declared as chronic infection or still in acute stage?
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Dear @anasaladan
Thanks for updating us again. I think this is a more easily interpretable result. It may be that your test 6 months ago was misinterpreted, as per @smart55’s suggestion. Your results now are consistent with a chronic infection, yes.
Thomas
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Hello, I’m new to this group. I was diagnosed with Hepb almost 30 years ago, I never took it seriously. Here are my lastest numbers. My fibroscan was good but doctor suggested a liver biopsy which I’m not comfortable with. In 3 months I’ll have more blood work drawn and potentially be placed on medication.
Will I ever be able to wine drink wine again???
Your Value
12,074 IU/mL
Standard Range
<=0.0 IU/mL
Flag
H
Hepatitis B (HBV), Log
Your Value
4.08 Log
Standard Range
<0.00 Log
Flag
H
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Dear @SLDJN1017,
Thanks for sharing your story. Good to hear that your fibroscan looked good. Did your doctor mention why a liver biopsy is necessary?
It is best practice to limit your alcohol, but an occasional wine is not going to accelerate your liver disease quickly. See here for a previous conversation about it: Vices - alcohol marijuana etc
Cheers,
Thomas
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He never gave a good reason for a liver biopsy. He just said if it showed any scaring we would then start treatment right away but if I’m against the biopsy, we will check my levels again in 3 months and treatment may be started at that time. I would be placed on entecavir.
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Thanks for responding. Here are my recent labs.
| GPT/ALT |
Your Value29 Units/L |
Standard Range<64 Units/L |
|
| GOT/AST |
Your Value24 Units/L |
Standard Range<=37 Units/L |
|
| Hepatitis B (HBV), Quantitative |
Your Value12,074 IU/mL |
Standard Range<=0.0 IU/mL |
FlagH |
| Hepatitis B (HBV), Log |
Your Value4.08 Log |
Standard Range<0.00 Log |
FlagH |
3 months prior my numbers were higher. They go up and down. Would it be helpful to share those as well?
I hope this helps.
Yes, these numbers can naturally go up and down.
Hi Docs and all member,
I had HBV since 2006. I start taking TAF from 2016 until now. Recently I have a few concern with my health since I feel my skin got a little bit yellowish than normal. I got a HBV and Liver Function Test on early September. everything is normal except I got a little bit of Ferritin (iron) elevated.
Here is my blood test result
Ferritin = 732 ng/ml
Bilirubin Total = 1.1 mg/dL
Bilirubin Direct = 0.3 mg/dL
ASAT = 18 UI/L
ALAT = 17 UI/L
Alkaline Phosphatase = 66 UI/L
GGT = 30 UI/L
Amylase = 64 UI/L
Albumine = 45g/l
AFP = 2.6
Fibroscan (echosen) = 3.0 kPa
Antigen Hbs (quantitative) = 1426 UI/mL
HBV Viral is undetected
With these result my local doctor said I am normal. however, I feel my skin color is a little bit yellow than normal during the last few months. shall there be any missing test? shall there be any recommend regarding my skin color change?
thank
My husband was diagnosed with HepB in September when he went to ER for abdominal pain. At that time his Alk Phos was 139 Int._Unit/L (High), ALT 776 Int._Unit/L (High), AST 558 Int._Unit/L (High), and Bili Total 0.8 mg/dL. Those were from September 26th.
Since then they said this was no big deal, your body will clear this on it’s own and we will just do routine blood tests to monitor it. He has continued to decline and now has jaundice.
Oct 19th - ALT 795, AST 710, Bili Total 2.8
Oct. 26th - ALT 813, AST 733, Bili Total 7.5
Oct 28th - ALT 757, AST 665, Bili Total 10.8
Oct 29th - ALT 756, AST 679, Bili Total 10.2
No one will explain what this means. They are only giving him morphine for pain? He has had 2 ultra sounds that came back normal and “unremarkable”. So signs of tumors, scarring, or abnormalities in size or shape?
His HepB Core Ab,Igm was reactive as was his HepB SurfaceAg. His SMA was positive and his AMT was 1:80.
Dear senhour,
Based on the test results, your HBV infection si very well controlled. There is no evidence of liver dysfunction. Your total bilirubin is VERY slightly above the normal range but this does not indicate something is wrong. Your bilirubin would have to be much higher to affect the color of your skin.
Any dietary changes? Are you outside more often then previously?
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Dear SamanthaMech,
Your husband has acute hepatitis B. Based on the results you have provided, your husband should be put antiviral therapy (entecavir or tenofovir disproxil fumarate) given the progressive and large increases in bilirubin. This is a sign that his liver is not functioning correctly. He may feel increased itching as a result of this elevated bilirubin.
Regardless of “unremarkable” ultrasound findings, there is a clear biochemical decompensation of your husbands’ liver function (as evidenced by his jaundice, which is caused by the very large increases in his bilirubin) which should not be allowed to persist if it does not start to immediately self resolve.
The current attending physician(s) is likely be operating under the assumption that his infection is acute (HBcAg IgM positive) and will resolve (as it does in ~80% of patients). However, the severe nature of the biochemical decompensation in your husband (bilirubin elevations) demands real supportive therapy to normalize liver function (antiviral therapy).
Best of luck.
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Thank you SO much for the information. I have gotten no where trying to ask questions of these doctors here. No one will bother explaining anything and any time I ask questions they basically don’t answer and just say I am “ill informed”. I have been reading so much information here and the Drs at the hospital just make me feel like I’m crazy? After 3 days of my husband sitting in an ER getting pain meds and NOTHING else, they have finally moved him to a real room and admitted him this morning. Since he was in the ER, they would not allow me to stay with him, so I am heading to the hospital to see what they are doing and why they finally admitted him after 3 days.
Again, thank you so much!
Hi SamanthaMech,
I am sorry to hear you are getting such a poor level of communication and consideration from the physicians. This is of course ABSOLUTELY unacceptable and unprofessional.
The medical facts are pretty obvious:
- Your husband has acute HBV.
- Your husbands’ liver function is decompensating. While the body can tolerate reduced liver function for sometime without lasting effects, the clear progression of reduced liver function in this patient should be cause for alarm and should be prevented if possible. Pain management will do nothing to treat this underlying issue.
- The use of NUC therapy is indicated to control the progression of liver disease in patients with chronic HBV. Current treatment guidelines indicate that waiting for acute HBV infection to self-resolve without therapy is only acceptable if the underlying hepatitis is not fulminant (which his bilirubin results indicate his hepatitis is).
The United States guidelines from AASLD are very clear on this point see page 1579 (section 6E) in https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29800.
The European guidelines from EASL are also equally clear see page 387 in https://www.journal-of-hepatology.eu/action/showPdf?pii=S0168-8278(17)30185-X.
Good luck!
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They refuse to administer antivirals of any kind. They are not a transplant hospital and because of that they say they cannot administer the meds. I have asked the attending Dr to contact another hospital that has a hepatologist and see if they are willing to administer the medication. He said he will call, but if they do agree and anything goes wrong, they too will have to try transferring him to a transplant hospital in Cleveland Ohio for my husband to receive the proper care or a transplant if needed?
They did finally admit him to this hospital and put him back on IV fluids. They also gave him Acetylcyitene to rid his liver of any Tylenol products. This just caused massive puking for an hour? 
I am currently waiting to hear if the other hospital near me is capable of administering the meds and/or for Cleveland clinic to have an open bed to treat him.
Again, I appreciate and thank you immensely for the information you have provided. I atleast have some hope that my husband could recover with out a transplant.
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Dear SamanthaMech,
To be frank none of the statements made by the doctors make any sense. TDF is the recommended and the preferred NUC for controlling fulminant hepaitis during acute HBV as is stated in the guidlines.
Atleast he is admitted with supportive IV.
I hope this turns out ok for your husband.
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Dear @availlant
Thank you so much for explanation and that it is not big concern. Anyway I have a few more concerns.
I am living in Cambodia, Southeast Asian Nation. I go out to work to work and exposed to sun light daily.
I think I don’t have any majore change in diet except I start to increase my vegetable consumption. Especially leafy green and cruciferous vegetables
1 - is there any indication that bilirubin will continue to increase?
2 - does my skin pigmentation could be related to ferritin level ?
3- how can I do to lower down bilirubin?
Thank
HI Senhour,
I don’t see any reason from the data you provided to expect that your bilirubin is troubling or will change over time but you should be followed on antiviral therapy every 6 months. However, elevated ferritin levels can result in a change in skin pigmentation. There are many possible reasons for elevated ferritin these should be investigated by your doctor.
Best regards,
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Hi @availlant
Thank again for more explanation. Yes my doctor told me to go back and check everything again in 6 months or less if I notice any major change to my body.
I will surely follow strict diet and continue on my TAF treatment.
No alcohol
No junk food
Less sugar
Less high fat food
More vegetables
Do regular exercise
Try to reduce stress
And have enough sleep
I will surely posting my updated blood test result in the next few months.
Thank
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Hi @availlant
I think I found the answer to my condition right now. Actually, jaundice is classified in three type Pre-Hepatic, intra-hepatic, and Post-Hepatic.
Based my felling of yellow in my skin ( I personally notice myself through in house under LED light with different light color variations (different color tone), outdoor under bright sunlight or cloudy sky.) I can conclude that my skin is a bit yellower than my normal skin.
According to this Jaundice Lab analysis video Jaundice: Differential Diagnosis - YouTube And my previous blood test result I personally think I got Pre-Hepatic jaundice
The indicators can be taken from previous blood test result are
Bilirubin Total = 1.1 mg/dL
Bilirubin Direct = 0.3 mg/dL
ASAT = 18 UI/L
ALAT = 17 UI/L
Alkaline Phosphatase = 66 UI/L
GGT = 30 UI/L
Amylase = 64 UI/L
Albumine = 45g/l
Red Blood Cell is a little bit lower than normal
According to this video to conclude Pre-Hepatic Jaundice are
Slight elevated Bilirubin
Normal Liver Function Test
Lower Red Blood Cell
If you have more explanation please.
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Dear senhour,
The upper limit of normal for total bilirubin is 1 mg/mL in most countries. Your reading of 1.1mg/mL is not really an increase which would be consistent with yellowing of the skin (or prehepatic jaundice). Jaundice is associated much higher levels of bilirubin than your tests indicate and will also be accompanied by a yellowing of the whites of your eyes (sometimes appearing brownish).
Again the elevated ferritin is the more likely culprit here but additional blood work is needed.
Unless this your skin condition changes and or your eyes become discoloured, I would relax on this issue but be sure to discuss it with your physician at your next visit.
Hope this helps.
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