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SUMMARY Serum alpha-fetoprotein (AFP) levels have been measured sequentially by a radioimmunoassay method in 64 patients with fulminant hepatic failure. In 15 of the 64 patients (23 %) AFP levels were raised but in only two did they exceed 500 ng/ml. Of the 23 survivors 11 (48 %) had raised AFP levels compared with four of the 41 (9-8 %) fatal cases (p < 0 005). This rise in AFP levels was found early after the development of grade IV coma and constitutes an encouraging prognostic sign at a time when the liver function tests and EEG are unhelpful. A radioimmunoassay must be used if these small but significant rises in plasma concentration are to be detected. Twelve patients survived without showing a rise in plasma AFP at anytime during the illness. The four fatal cases who had raised AFP levels all had serious complications of fulminant hepatic failure. Charcoal haemoperfusion did not seem to increase the survival of AFP negative patients.Alpha-fetoprotein (AFP) is a serum a,-globulin present in very low concentration in normal adult serum.

SUMMARY Grossly raised levels of tumour related vitamin B12 binding protein, reflected by rises in serum vitamin B12 and unsaturated vitamin B12 binding capacity (UBBC), were found in three of 44 patients with hepatocellular carcinoma. All three were HBsAg negative and had normal serum alpha fetoprotein levels. The patients did not have underlying cirrhosis and the tumours contained characteristic intracellular inclusions. In the first patient the UBBC level fell during a paitial remission induced by adriamycin therapy and in the second patient UBBC levels rose with progression of her disease. In the third patient serum B12 binding protein levels fell after tumour resection. Assay and subsequent monitoring of serum vitamin B12 and UBCC may prove valuable in the assessment and follow-up of some patients with hepatocellular carcinoma whose alpha fetoprotein levels are normal.

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