EXPLAINER: Lab results and their interpretation

Thank you all for helping the community,
I am diagnosed with HBV recently.
I am doing some tests such as routine tests and DNA test,
Most of them are ready.

Please help me to understand my situation, I am so lost and scared since my test was positive.
I started my treatment with a expert doctor but it takes so long to tests becomes ready.

Some of the results are as mentioned below:

HbsAg: 24 (Reactive)
HbsAb: NonReactive
HbcAb(total): Reactive
Hbc(Igg) : Non-Reactive
Hbc(Igm): Non-Reactive
HbeAg : Non-Reactive
HbeAb: 0.05(Reactive)
Protein-Total: 7.7 (Normal)
Alboumin: 4.8 (Normal)
Globulin: 2.9 (Normal)
Billirubin-Total: 1.3
Billirubin-Direct: 0.38
Billirubin-Indirect: 0.92
ALT: 27
AST: 20
Alk-Phosphatase: 89(Normal)
Sono-Liver: It was normal but a little bit fatty liver

Dear @IWillBeCured,

Welcome to the community and thanks for sharing your results.

These are consistent with the immune control phase, which has a good prognosis. The sonography seems to show that your liver is doing well and hasn’t got any signs of liver damage, which is also great. It would be worth getting a HBV DNA test to see what your viral titres are to see if you would benefit from treatment.

Hope this helps,
Thomas

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Thank you Thomas, for responding and helping me.
I have accidentally found it by checkup. I did not start any treatment yet, and did not use any medicine. because my doctor need more tests. DNA test would be shared as soon as it becomes ready.

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Dear @ThomasTu
Can you describe what do you mean by immune phase control ? And how it happens.

Hi @ThomasTu and @availlant

I finally received all my labs. Please see below.

I am Hbeag negative, ant Hbe positive.
HBV DNA is. 6290
HBsAG Quantitative is: 1442iu/ml

My AFP decreased from 16 down to 9.2 (still high -normal is 6.9)
AFP L3% is undetectable/negative
DCP negative
Fibrosure test: no fibrosis (F0-F1)
minimal inflammation (.33)

Hep Delta Negative
Hep C Negative

Alt : 49
AST : 27
Total bilirubin .0.6
Direct .2

Fibroscan is pending…

My doctor is recommending treatment since todays best recommendations is to start treatment earlier… I agree with that…I will also meet with Dr Gish again.

Since my HBsAG quantitative is 1442, can I benefit from pegylated-IFN with TAF??
What’s probability clearing HBsAG this level??
I saw several literature showing higher probability to clear HBsAG level <1500.

What’s your thoughts?
Please advise.

Thanks
Nass

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Dear Nass,

Functional cure with TDF/TAF and pegIFN is achieved in ~9% of patients with the easier to treat genotypes (A and B). With harder to treat genotypes (C and D) functional cure is only very rarely achieved with TDF/TAF and pegIFN.

These functional cure rates are better when HBsAg is < 1500 (and really < 1000) IU/mL but still only in a minority of patients. This is not to discourage you from considering adding pegIFN as this is the only currently approved agent which can achieve functional cure.

Starting TDF/TAF right away is the best choice to minimize HCC risk down the road.

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Thanks availlant…
I will talk to the Dr about the specifics…

In the meantime, we hope that Rep 2139 will be approved soon within 3-4yrs!!!

Thanks for your help….
Nass

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Dear @ThomasTu and @availlant
I have all tests ready now,
Just for more information, I accidentally found my hbv during recent checkup, (last year checkup everything was fine)
I really need your help to understand my situation and what can I do for future.

HbsAg : 24 (Reactive)
HbsAb : NonReactive
HBV-PCR-QUANTITY: 193 IU/ml
HbcAb(total) : Reactive
Hbc(Igg) : Non-Reactive
Hbc(Igm) : Non-Reactive
HbeAg : Non-Reactive
HbeAb : 0.05(Reactive)
Protein-Total : 7.7 (Normal)
Alboumin : 4.8 (Normal)
Globulin : 2.9 (Normal)
Billirubin-Total : 1.3
Billirubin-Direct : 0.38
Billirubin-Indirect : 0.92
ALT : 27
AST : 20
Alk-Phosphatase : 89(Normal)
Sono-Liver : It was normal but a little bit fatty liver

Dear @IWillBeCured,

Your low viral load is an indicator of good outcomes and you are at low risk of transmitting the virus onwards to other people.

Hope this helps,
Thomas

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Dear All experts,

After a few months ( from 30 August to 12 December 2022) I got another follow up result. overall is okay but I got lower red blood cell than the normal rang. my doctor told me that it is probably i am lack of eating nutritional foods. overall i am feeling okay. I Just sometime feel a bit tension on my right ribs and my skin look pale than usual ( Anemia Maybe?). my doctor also told me the same for my skin condition.

Anyway, please help check and blood test result and feedback if any. all feedback are very important for me.

Red Blood Cell : 3.92 T/L ( previous result : 4.08 T/L)
Hemoglobin : 12.1 g/dl ( previous result : 12.6 g/dl)
Hematocrite : 35.1 % ( previous result : 38.6 % )
MCV : 89.5 fl ( previous result : 94.6 fl )
White Blood Cell : 7800 /mm3 ( previous result : 5900 /mm3 )
Plaquettes : 220 G/l ( previous result : 236 G/l )

Ferritine : 423.7 ng/ml ( previous result : 743.2 ng/ml )

Vitamin D : 34.09 ng/ml ( previous result : 22ng/ml )

Amylase : 76 UI/L ( previous result: 64 UI/L )
ASAT: 26 UI/L ( previous result : 18 UI/L )
ALAT: 22 UI/L (previous result : 17 UI/L )
GGT: 23 UI/L ( previous result : 30 UI/L )
Alkaline Poshatate: 56 UI/L ( previous result : 66 UI/L )
Albumin: 48 g/L ( previous result : 45 g/L )

AFP : 1.7 ng/ml ( previous result : 2.6 ng/ml )

HBe Antigene : Negative 0.4
Anti HCV : Negative
Anti HBs : Negative
HBs Antigen : Positive
HBs Antigene : Positive 1317 UI/ml ( previous result : 1426 UI/ml )

Ultrasound : Normal
Fibroscan : 4.9 kPa

What does really cause my red blood cell to be lower like this?
shall i worry about this condition? what will probably go bad?
Am i in state of Anemia of Chronic Inflammation?

Thank you very much

Dear experts,
I have a question about Alat and Asat values. I have noticed that whenever they are within the range ( not elevated), there is a tendency for Asat to be higher than Alat. Is my observation correct? Is it safe to assume that Asat values tend to be higher than Alat? I know there is a different story when we talk about the elevation of those two but I am interested to know if Asat Is typically higher than Alat in healthy liver?

Dear @senhour,

Just to mention again, I am not a clinical doctor. You are on the lower side of normal and it’s not a big change from your previous results, so I would not expect that there has been a dramatic change in your body. It is worth continuing monitoring to see if it is trending downwards. Your ALTs are normal, so I wouldn’t expect that it’s due to Hep B-related inflammation. Appropriate nutrition may affect red blood cell count and is worthwhile seeing if this is the issue with changes in diet.

I’m not sure I have seen any data on this and haven’t heard about whether this has any clinical significance in people with healthy livers.

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Dear @ThomasTu

thank you for your response. I just feeling not easy with my blood test. because Hematocrite is one of the many important factor for HepB patient.

I really want to know what exactly cause this complication. I hope other people or doctor in here have similar experience and can share what they can do best to fix this issue.

thank

Senhour

One thing I noted from your labs is th HBsAG quantitative reduction… it decreased by 109 points within 3 moths…

Are you taking meds? I guess that is something you should be happy about…

Dr Thomas/availlant

Does HBsAG level decrease only? Or it fluctuates up and down?

Thanks in advance!
Nass

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Yes @Nass I am on TAF medication.

For my case it was fluctuate. Last year I got HBs Antigens lower than 1000.

Dear @senhour,

I think red blood cell count can be affected by many things. It is not easy to diagnose you over the internet and would be irresponsible to say anything definite. It is also a bit outside the expertise of this forum, as it is not necessarily due to the Hep B. It is best that you visit a doctor about this so that they can examine you for the various causes that it could be.

HBsAg can fluctuate up and down. This change is within 10% of the previous result and could be natural variation or variation in the test.

Thomas

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Thank you again Dr. @ThomasTu

I am just worry and curious at the same time. I visit two doctors with these blood test result. They suspect that the low hemoglobin may result from malnutrition.

They suggest me to eat more balance nutritional food and closely monitor and follow up in the next few months.

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Hi @ThomasTu ,

My HbsAg level increased from 12k to 28k within year. is it usual ? what could be the reason of so much increase

Hi all members

There are two test for non invasive liver scan ( biopsy alternative)

There is FibroScan and FibroTest (FibroSure in the U.S)

Do you have any ideas of this two? Which one is more accurate?

Thanks

Dear Senhour,

Fibroscan is a direct measure of your liver stiffness using a technique similar to ultrasound called transient elastography. FibroTest / FibroSure predict fibrosis from a series of blood tests.

Both approaches can estimate the extent of fibrosis but Fibroscan is more sensitive to physical changes in the liver cause by portal vein hypertension (a symptom of advanced fibrosis or cirrhosis).

In the goal of this assessment is to understand the need to start treatment for chronic HBV infection, both are useful for this purpose.

Best regards,

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