Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (168 page)

   Often associated with preeclampsia (see Chapter
8
, Renal and Urinary Tract Diseases).

   Laboratory Findings

   
Histology
: Biopsy of the liver confirms the diagnosis.

   
Core laboratory
: Increased AST and ALT to approximately 300 U (rarely >500 U) is used for early screening in suspicious cases; ratio is not helpful in differential diagnosis. Serum bilirubin may be normal early but will rise unless pregnancy terminates. Serum uric acid is increased disproportionately to BUN and creatinine, which may also be increased. Blood glucose is often decreased, sometimes markedly. Blood ammonia is usually increased. Neonatal liver function tests are usually normal but hypoglycemia may occur.

   
Hematology
: Increased WBC in >80% of cases (often >15,000/μL). Evidence of DIC in >75% of patients.

NEOPLASMS OF THE LIVER: HEPATOCELLULAR CARCINOMA (HEPATOMA)

   Laboratory Findings

   
Core laboratory
: Serum AFP may be increased for up to 18 months before symptoms; is a sensitive indicator of recurrence in treated patients, but a normal postoperative level does not ensure the absence of metastases. Levels >500 ng/dL in adults strongly suggest hepatoma. Levels >100× URL have S/S = 60%/100%. In ≤30% of hepatoma cases, AFP <4× URL; such increases are common in chronic HBC and HCV. Serum GGT hepatoma–specific band (HSBs I′, II, II′) by electrophoresis activity >5.5 U/L has S/S = 85%/97%, accuracy = 92%. Does not correlate with AFP or tumor size.

   
Hematology
: ESR and WBC sometimes increased. Anemia is common; polycythemia occurs occasionally. Hemochromatosis (≤20% of patients die of hepatoma).

   
Serology
: Markers of viral hepatitis are frequently present.

   
Tumor markers
: Serum CEA is usually normal. CEA in bile is increased in patients with cholangiocarcinoma and intrahepatic stones but not in patients with benign stricture, choledochal cysts, and sclerosing cholangitis. Increases with progression of disease and declines with tumor resection.

Considerations

   Sudden progressive worsening of laboratory findings of underlying disease (e.g., increased serum ALP, LD, AST, bilirubin).

   Relative absence of hepatoma associated with cirrhosis of Wilson disease.