Interest of transjugular liver biopsy in adult patients with haemophilia or other congenital bleeding disorders infected with hepatitis C virus

Abstract

SummaryLiver histology is important for prognosis and treatment strategy in patients with hepatitis C. We report a 10-year experience of transjugular liver biopsy (TJLB) in patients with haemophilia and other congenital bleeding disorders (CBD) in terms of safety, efficiency and therapeutic consequences. TJLB was proposed to patients who were regularly followed for CBD, and were hepatitis C virus (HCV) positive by polymerase chain reaction. Patients with inhibitors or who were human immunodeficiency virus (HIV) positive with CD4 cells <0AE2 · 10 9 /l or with evidence of liver failure were excluded. TJLB was performed during a short hospitalization with factor replacement.

Role of transjugular liver biopsy in the diagnostic and therapeutic management of patients with severe liver disease

“…Percutaneous biopsy was contraindicated because of severe thrombocytopenia (defined as a platelet count <50×10 9 /l) (44; 58%), severe coagulopathy [international normalised ratio (INR) >1.5] (3; 4%), marked ascites (3; 4%) or a combination of the above (26; 34%) [5][6][7]. Table 1 shows the clinical indications for transjugular liver biopsy in our series.…”

“…Coagulopathy and thrombocytopenia were the principal indications for the transjugular approach [3][4][5] and were encountered in combination or separately in 52 procedures (68%). In addition, because thrombocytopenia and/or coagulopathy were also considered the main indications in the 21 cases in which they were associated with ascites (28%), the two conditions accounted for 96% of all indications for transjugular biopsy.…”

“…Transjugular biopsy allows histological samples to be acquired from patients in whom percutaneous puncture is contraindicated [5,6]. After 6 years of experience as interventional radiologists of the Ospedale Maggiore Policlinico in Milan, we decided to evaluate the impact of transjugular liver biopsy on the diagnostic and therapeutic management of patients with severe liver disease.…”

“…Il prelievo bioptico per via transgiugulare permette di ottenere campioni istologici in pazienti per i quali la puntura per via percutanea è controindicata [5,6]. Dopo un'esperienza di 6 anni dei radiologi interventisti dell'Ospedale Maggiore Policlinico di Milano, abbiamo voluto valutare l'impatto di questa procedura nella valutazione diagnostica e nella gestione terapeutica di pazienti epatopatici gravi, con disfunzioni sia acute, sia croniche della funzionalità epatica.…”

“…A questo scopo, abbiamo revisionato le cartelle cliniche di tutti i pazienti che si sono sottoposti alla procedura in questo periodo di tempo. [5][6][7]. La Tabella 1 presenta le situazioni cliniche che hanno motivato l'esecuzione di una biopsia epatica per via transgiugulare.…”