Same day outpatient transjugular liver biopsies in haemophilia

Abstract

Patients with haemophilia are at increased risk of hepatitis C infection because of prior transfusion of blood products. Virtually all haemophiliacs who received pooled blood products before the mid-1980s have been infected with hepatitis C. A liver biopsy is important to identify the extent of liver disease, and to help determine the necessity of interferon therapy. With factor replacement, in-hospital liver biopsy is safe. Thirty patients with haemophilia were evaluated for chronic hepatitis C infection. Eleven patients subsequently underwent successful transjugular liver biopsy in the outpatient setting after appropriate factor replacement. Mean +/- SD pre- and posthaemoglobin values were 15.8 +/- 0.79 and 14.4 +/- 0.71 g dL(-1) (P = ns). There was no significant change in heart rate, systolic or diastolic blood pressure during the monitoring period (P = ns) and no major complication was noted in perioperative follow-up. The mean length of the liver biopsy specimens was 1.7 +/- 0.3 cm, mean grade was 2 +/- 0.6 and mean stage was 2.3 +/- 1.2. Our experience demonstrates that outpatient transjugular liver biopsy can be safely performed in patients with haemophilia in the outpatient setting, avoiding the cost and need for hospital admission.

Transjugular liver biopsy – Indications, adequacy, quality of specimens, and complications – A systematic review

“…The mean number of passes was not significantly associated with the mean length (r = 0.34, p = 0.1). Specimens obtained with P3 passes were not significantly longer compared to those obtained with <3 passes (15.2 [9-22.5] mm vs. 12 [7][8][9][10][11][12][13][14][15][16][17] …”

“…TJLB establishes diagnosis and may be prognostic in early ALF [12,13]. It is also a safe alternative in patients with severe congenital bleeding disorders requiring less replacement therapy and can even be an outpatient procedure [15,16], whereas PLB has an increased risk of bleeding [77,78], as high as 12.5% [79], and high mortality (1%) [79]; many of these patients are also infected with HCV [80]. TJLB has a specific role in bone marrow transplantation and chronic renal failure, in which conditions, liver disease is an important cause of morbidity and mortality [81,82].…”

“…TJLB is usually indicated when PLB is contraindicated due to coagulopathy and/or ascites [2,6], in liver transplant recipients [7][8][9][10][11], and patients with acute liver failure (ALF) [12,13] or congenital clotting disorders [14][15][16][17][18].…”

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

“…The most significant results were seen in subgroup A, with 67% of changed diagnoses. Furthermore, in 8/15 cases (53%) with a definitive diagnosis (subgroup C), the biopsy result guided treatment that otherwise would have been empirical [13][14][15][16]. Thus, the procedure proved most useful in group 1, considering that a final diagnosis was established in 40/44 cases (91%).…”

“…Inoltre in 8 casi su 15 (53%) con diagnosi definitiva (sottogruppo C), si è potuta instaurare una terapia altrimenti non proponibile se non empiricamente [13][14][15][16]. L'utilità della tecnica in questo gruppo è stata elevata considerando che su 44 casi si è pervenuti a una diagnosi definitiva in 40 (91%).…”