28th July: World Hepatitis Day
Editor: Dr. Praful B. Godkar (Ph.D)
Eminent Author, Medical Biochemist and Scientist Educational and Technical consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
The liver is a vital organ that performs numerous functions to maintain the internal stability of the body (homeostasis). Disruption in the homeostasis takes place in liver diseases and the affected person may suffer from hepatitis, (inttam- mation of liver cell) and jaundice (yellow coloration of skin, eyes and urine, Ref. Answers of Q1 and Q2). The liver has a unique ability to regenerate itself after damage. However, uncontrolled liver diseases could harm it beyond the point of repair and a person may suffer from chronic liver disease (CLD). CLD is the 11th leading cause of mortality and morbidity across the world. Improved preventive strategies, self-care tests and timely performed liver function tests (LFTs) with complete hemogram could be useful to diagnose the type of jaundice and facilitate timely treatment to prevent further progression of the liver disease (Ref. Answers of Q2-4).
Q1. What are the various general causes of liver diseases?
ANS: The various general causes of liver diseases include; infections caused by viruses (Hepatitis A, B, C, E, G and Corona), bacteria (leptospira), pathogenic protozoa (ameba), parasites (malarial parasites), metabolic disorders (uncontrolled diabetes mellitus), excessive alcohol intake, cancers, autoimmune disorders, adverse drug (acetaminophen) and toxic chemical reactions (carbon tetrachloride). Historically, viral hepatitis has been the leading cause of CLDs. The great majority of clinical significant hepatitis infections are due to hepatitis A (HAV, spread through polluted materials and hepatitis B infections (HBV, spread through parenteral routes).
Q2. What preventive care is taken to prevent HAV and HAB infections? What self-care tests could be useful to detect jaundice?
ANS:
Prevention of HAV:
Use of safe-drinking water and foods, avoidance of non-heated foods while having outdoor meals, and following strict personal hygiene.
Prevention of HBV:
General persons:
- Performing blood tests at an accredited clinical laboratory,
- Donating and receiving blood at a center where all standard safety protocols are followed
- Avoidance of drugs, unsafe sex and tattooing.
Laboratory and Hospital staff (that collect and handle patient’s specimen):
- Avoiding needle-stick and surgical instrument injuries and following of all safety protocols
- Vaccination against HBV
Self-care tests: In the case of prolonged loss of appetite and nausea, check the color of first morning urine (keeping in mind the color of medicines, and foods, if any), and observe color of skin and eyes (sclera). Yellow coloration of urine, sclera and skin indicate jaundice.
Q3. What are the general Liver Function Tests (LFTs) prescribed? How these tests are useful in the diagnosis of liver disease?
ANS: The generally performed LFTs are:
Serum bilirubin, SGPT, SGOT, alkaline phosphatase, total proteins, albumin and gamma-glutaryl transferase. These tests are able to diagnose jaundice, differentiate type of jaundice (whether it is related to hemolytic type, hepatic or due to obstruction to bile circulation), follow the trend of the disease, and confirm complete recovery or chronic stage. Mostly viral hepatitis is caused due to HAV or HBV resolves in four weeks with appropriate rest, diet control and complete avoidance of alcohol. If jaundice fails to resolve after five weeks, advanced tests are required to identify the virus, viral load and to monitor the chronic phase and to cure the patient.
Q4. What are the advanced tests and the impact of advanced technology and biomarkers in the identification and study of the course of viral disease and the related chronic phase in the case of hepatitis B virus infection?
ANS: RT-PCR tests can identify the specific virus and also the viral load so that the physician could use appropriate treatment for the recovery of the patient.
The hepatitis biomarkers used to identify chronic hepatitis caused by hepatitis B virus are:
Hepatitis B surface antigen, Hepatitis Be antigen, Hepatitis c antigen, IgM anti-Hbc, and anti-Hbc. These hepatitis markers are useful to diagnose early phase of hepatitis B, recovery phase, complete recovery or continuity of the chronic phase. Advanced laboratory technology backed by robotics, automation and artificial intelligence; enable very fast and accurate genera- tion of test reports.The latest introduced intelligent Liver Function Testing (iLFT) methodology based on intelligent predictive algorithms is a novel, automated system designed to improve early diagnosis of liver disease (Ref 5).
Q5. What is the impact of life-style diseases in the increase in the number of liver diseases?
ANS: One All India Institute of Medical Sciences (AIIMS) study paper published in Journal of clinical and experimental hepatology (2020) states that about 38% Indians have alcoholic fatty liver and Non-Alcoholic Fatty Liver Disease (NAFLD). Excessive alcohol consumption leads to excessive deposition of fatty acids in liveralong with collagen, leading to hepatocellular damage, fibrosis and fibroid part of liver becomes hard and non-functional. The risks of NAFLD include obesity, high levels of serum cholesterol and triglycerides, uncontrolled type-2 diabetes mellitus and other metabolic disorders. Screening of high-risk persons for early diagnosis of NAFLD is necessary to prevent and monitor further progression of the disease. Latest IVD tests and markers for LFT could be extremely useful in monitoring NAFLD. (6)
Q6. What is leptospirosis and why there is a rise in leptospirosis cases during rainy season, which may lead to liver disease during rainy seasons?
ANS: Leptospirosis is an infection caused by leptospira bacteria, which infects animals (domestic animals and rats). It is transmitted from infected animals through their urine, infected soil or water. Humans become infected through contact with water, food, or soil containing urine from the infected animals or through skin contact or exposing open wounds to infected water. Initial leptospirosis symptoms are similar to flu. In the second phase of the infection, leptospira may severely infect liver, kidneys and brain. The complications of leptospirosis include, liver failure, renal failure, meningitis, respiratory distress, hearing loss, etc. During rainy season it is necessary to prevent walking through water-logged areas. Diagnosis of leptospirosis is confirmed with tests such as ELISA and RT-PCR.
Q7. What is the significance of complete hemogram (CBC) as an additional test with LFTs?
ANS: Generally, total WBC count is not significantly increased in viral infections, unless secondary bacterial infection is present. High WBC count mainly indicates bacterial infection. Low levels of lymphocytes and high levels of neutrophils indicate viral infection, and Neutrophils/lymphocytes ratio (NLR) increases. Platelets may decrease significantly if severe viral infection leads to intravascular coagulation.
Increase in PDW and MPV indicate viral infection, and thrombocytopenia (decrease in platelets). PDW increases when number of platelets decreases significantly and increase in MPV indicates severe inflammatory reactions, due to viral infection. P-LCR (platelet large cell ratio) is another parameter, which indicates thrombolytic complications. In malarial hepatitis, the percentage degree of decrease in the red blood cells due to infection, and also the change in related parameters, HCT, MCH, and MCHC, indicate degree of severity and type of anemia (whether normochromic or hypochromic?).
References
- Adam C Sheka 1, Oyedele Adeyi 2, Julie Thompson 3, Bilal Hameed 4, Peter A Crawford 5, Sayeed Nonalcoholic Steatohepatitis: A Review. JAMA (2020), Apr 28;323(16):1619.
- Srinivasan Thiagarajan 1, Sadhanandham Shrinuvasan 2, Thiruna- vukkarasu Arun Screening for non-alcoholic fatty liver disease among obese and overweight children: Prevalence and predictors. Indian J Gastro- enterol (2022) Feb;41(1):63-68.
- Ying Hu, Yufeng Lou, Youmei Chen, Weilin mao. Evaluation of MPV in patients with hepatitis B virus infection. Int. J. Clin. Exp. Med. (2014); 7(11): 4207-4213.
- Jennifer Nobes, Damien Leith, Sava Handjiev, John F. Dillon, Ellie Dow. Intelligent Liver Function Testing (iLFT): An Intelligent Laboratory Approach to Identifying Chronic Liver Diagnostics 2024, 14(9), 960.
- Godkar PB, Godkar Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
