Living with Hepatitis C
Life with hepatitis C means lots of blood tests to monitor your condition. Have you ever wondered what the numbers really mean? This information will review the warning signals of five basic blood tests:
2. Bilirubin
3. Albumin
Lab Tests (normal values)
Liver Enzymes: A liver cell produces proteins, called enzymes, that live within the cell or its membranes. Enzymes are catalysts that help a liver cell do it’s job of creating the specific chemical changes that give your body fuel to live. Here are the names of the enzymes you need to remember:
· ALT (SGPT) – Alanine Aminotransferase.
· AST (SGOT) – Aspartate Aminotransferase.
· GGT – Gamma-Glutamyl Transferase.
· Alkaline Phosphatase.
Your liver creates all of these enzymes. When liver cells are injured, destroyed, or die, the cell becomes leaky, and the enzymes escape into the blood that’s circulating through the liver. When the cell is injured, liver enzyme levels in the blood rise. If small numbers of cells are affected, there may be little or no increase in plasma levels of enzymes. When large numbers of liver cells are injured or die, the levels of these enzymes in plasma increase markedly. Massive liver injury is associated with marked increases in ALT; mild injury may be associated with mild-or even no-increase in ALT. The correlation is strongest at earlier stages of hepatitis C, before the development of cirrhosis. However, once cirrhosis occurs, ALT levels may not be high; therefore, ALT is no longer a good indicator of further liver damage.
Typical hepatitis C patients show increases in ALT and AST …but little or no increase in GGT and alkaline phosphatase. Those with cirrhosis or who have an underlying disorder of the biliary tract may have modest elevations in GGT and alkaline phosphatase. Patients tend to focus on their ALT and AST counts; but other tests are more important in measuring the health of your liver.
Bilirubin: This is the yellow pigment responsible for jaundice. When red blood cells in your body breakdown, they release hemoglobin…a molecule that carries oxygen to your tissues.
Normally, the amount of bilirubin produced approximates the rate of red blood cell breakdown. Bilirubin levels rise when something goes wrong, such as the breakdown of to many red blood cells, the development of liver disease (hepatitis), a defect in liver metabolism, or a blockage of the bile system. Bilirubin accumulates in tissues, causing your skin and the white part of your eyes (sclera) to turn yellow.
Blood levels of bilirubin tend to fluctuate in patients with hepatitis, although a prolonged persistent elevation in bilirubin usually means severe liver dysfunction and possibly cirrhosis. When the liver fails to eliminate bilirubin from the blood, the skin and whites of the eyes turn yellow (jaundice), urine darkens, and the color of the stool lightens.
Albumin: This protein is made in the liver. It is vital for maintaining body fluid balance, especially the volume of plasma in your blood. It is the most predominant protein in blood plasma.
Although albumin levels in plasma may be affected by other disorders, in liver disease the level of serum albumin is a good marker of you liver’s ability to produce proteins. A sustained decrease below the normal range is one of the first signs of advancing liver disease.
When albumin levels drop to extremely low levels, fluid may leak out of the blood vessels into the surrounding tissues. This causes swelling, also known as edema. Normal albumin levels range between 3.5 and 4.5 grams/deciliter. Usually, edema occurs when levels drop below 2.5 grams/deciliter.
Unlike liver enzyme increases, which occur within hours to days of the liver injury, albumin levels don’t fall unless there has been chronic progressive liver injury for at least one month or more. A decrease in serum albumin, therefore, reflects a slowly progressive, ongoing reduction in the liver’s ability to synthesize this protein.
Clotting Factors: The liver also synthesizes many proteins that maintain normal blood clotting. In contrast to albumin, which stays a long time in plasma, clotting factors have a relatively short survival period. Therefore, the liver must constantly work to produce enough coagulation factors to maintain normal clotting.
Prothrombin time is the name of the most common test that measures a combination of blood clotting factors. If your prothrombin time increases, it means your liver isn’t creating enough factors, so it takes your blood longer to clot. Patients who have persistent, prolonged elevations in prothrombin time that don’t respond to vitamin K may need to be considered for liver transplantation.
Complete Blood Count (CBC): The complete blood count test can be a detection system for liver scarring. When the liver becomes scarred, it creates resistance to this blood flow( portal hypertension), and the blood may back up into the spleen. Patients with portal hypertension from cirrhosis of the liver often have low counts. Similarly, patients may have an enlarged spleen, resulting from severe cirrhotic disease, and may need to be considered for a liver transplant.
***Be sure to ask for copies of all your tests***
Wellness Approach
Crossroad illnesses, like hepatitis C, present opportunities for prioritizing our lives. Cure is not the operative word in the prudent plan for wellness, but wise and slow progress can go a long way in improving the quality of our lives. We can begin by placing our names on prayer lists to request healing and guidance in living with hepatitis. Secondly, we can benefit by getting good medical and psychological care, taking nature walks, meditating, exercising, eating nutritional foods, using herbs and vitamins, living in the moment, keeping a journal, deepening our relationships, having fun, and exploring our creative and spiritual appetites.
Lab Tests
Liver Enzymes:
· AST: 40 normal/40 to 200 mild to moderate/ 200+ severe.
· ALT: 40 normal/40 to 200 mild to moderate/ 200+ severe.
· GGT: 60 normal/ 60 to 200 mild to moderate/ 200+ severe.
· Alkaline Phosphatase: 112 normal/ 112 to 300 mild to moderate/ 300+ severe.
Liver Function Tests:
· Bilirubin: 1.2 mg/dl normal/ 1.2 to 2.5 mild to moderate/ 2.5+ severe.
· Albumin: 3.5 to 4.5 normal/ 3.0 to 3.5 mild to moderate/ 3.0 severe.
· Prothrombin Time: 14 seconds normal/ 14 to 17 mild to moderate/ 17+ severe. Note: These values depend on the laboratory where the test is done. Ask your laboratory for their normal reference values before jumping to conclusions.
Blood Count:
· White Blood Count: 6,000 normal/ 3,000 to 6,000 mild to moderate/ 3,000 severe.
· Hematocrit: 40 normal/ 35 to 40 mild to moderate/ 35 severe.
· Platelet Count: 150,000 normal/ 100,000 to 150,000 mild to moderate/ 100,000 severe.
