What are the main types of viral hepatitis. How do hepatitis A, B, and C differ in symptoms and transmission. Who is at highest risk for contracting hepatitis viruses. Why is testing important for diagnosing chronic hepatitis infections.

Understanding the Different Types of Viral Hepatitis

Hepatitis is an inflammatory condition affecting the liver, often caused by viral infections. The most common forms are hepatitis A, B, and C. Each type has distinct characteristics in terms of transmission, symptoms, and long-term effects.

Key Differences Between Hepatitis A, B, and C

• Hepatitis A: Usually mild and self-limiting
• Hepatitis B: Can become chronic, potentially leading to liver damage
• Hepatitis C: Often chronic, with risk of serious liver complications

Understanding these differences is crucial for proper diagnosis, treatment, and prevention strategies.

Recognizing Symptoms of Hepatitis Infections

Hepatitis symptoms can be subtle or nonexistent in the early stages, making detection challenging. When present, common symptoms across all types include:

• Fatigue
• Nausea
• Poor appetite
• Abdominal pain
• Mild fever
• Jaundice (yellowing of skin or eyes)

Are these symptoms always present in hepatitis infections? No, many people may be asymptomatic, especially in the acute phase or with chronic hepatitis B and C. This underscores the importance of regular testing for those at risk.

Hepatitis A: The Food and Water-Borne Virus

Hepatitis A is highly contagious but typically causes only mild illness. It spreads primarily through contaminated food or water, often due to poor hygiene practices.

Transmission Routes for Hepatitis A

• Consuming contaminated food handled by infected individuals
• Drinking contaminated water
• Close personal contact with an infected person
• Exposure in daycare centers with inadequate sanitation

Who is most at risk for hepatitis A? Travelers to regions with high infection rates and children in daycare settings face elevated risks. Consuming raw or undercooked foods, especially shellfish, can also increase the likelihood of infection.

Hepatitis B: The Blood and Body Fluid Transmitter

Hepatitis B can cause both acute and chronic infections. While many adults clear the virus naturally, it can lead to serious liver problems if it becomes chronic, especially in infants.

Common Transmission Methods for Hepatitis B

• Unprotected sexual contact
• Sharing needles or personal items with infected individuals
• Mother-to-child transmission during childbirth
• Accidental needle sticks in healthcare settings

What factors increase the risk of hepatitis B infection? Multiple sexual partners, intravenous drug use, and occupational exposure to blood in healthcare settings are significant risk factors. Additionally, being born to an infected mother poses a high risk for infants.

Hepatitis C: The Silent Liver Attacker

Hepatitis C often becomes a chronic infection, potentially leading to severe liver complications if left untreated. However, effective treatments are available.

Primary Modes of Hepatitis C Transmission

• Sharing needles or equipment for drug injection
• Receiving unscreened blood transfusions (before 1992)
• Mother-to-child transmission during pregnancy
• Unsterile tattoo or piercing procedures

Why is hepatitis C often called a “silent” disease? Many people with chronic hepatitis C remain asymptomatic for years, allowing the virus to damage the liver without obvious signs. This emphasizes the need for testing in high-risk populations.

The Importance of Hepatitis Testing and Screening

Early detection of hepatitis infections is crucial for effective management and prevention of liver damage. Blood tests can accurately diagnose viral hepatitis and determine the specific type.

Who Should Get Tested for Hepatitis?

1. Individuals with a history of intravenous drug use
2. People with multiple sexual partners
3. Healthcare workers with potential blood exposure
4. Individuals of Asian heritage (higher risk for hepatitis B)
5. Anyone born between 1945 and 1965 (for hepatitis C)

How often should high-risk individuals be tested for hepatitis? Regular testing intervals depend on ongoing risk factors, but annual screening is often recommended for those with continuous exposure risks.

Preventing Hepatitis Infections: Strategies for Protection

Prevention is key in reducing the spread of hepatitis viruses. Each type has specific prevention strategies based on its transmission methods.

Hepatitis A Prevention

• Vaccination
• Proper hand hygiene, especially after using the bathroom and before handling food
• Avoiding raw or undercooked foods in high-risk areas
• Drinking bottled or boiled water when traveling to regions with poor sanitation

Hepatitis B Prevention

• Universal vaccination, especially for newborns
• Using protection during sexual activity
• Avoiding sharing needles or personal items like razors or toothbrushes
• Implementing safety protocols in healthcare settings

Hepatitis C Prevention

• Avoiding sharing needles or drug paraphernalia
• Ensuring sterile conditions for tattoos and piercings
• Practicing safe sex, especially for those with multiple partners
• Screening blood donations (implemented since 1992)

Can lifestyle changes help prevent hepatitis infections? Yes, adopting safe practices like proper hygiene, safe sex, and avoiding shared needles significantly reduces the risk of contracting hepatitis viruses.

Treatment Options for Hepatitis Infections

Treatment approaches vary depending on the hepatitis type and whether the infection is acute or chronic.

Hepatitis A Treatment

Hepatitis A typically doesn’t require specific treatment and resolves on its own. Supportive care focuses on managing symptoms and ensuring proper nutrition and hydration.

Hepatitis B Treatment

Acute hepatitis B often clears without treatment. For chronic cases, antiviral medications can suppress the virus and slow liver damage. Regular monitoring is essential to track disease progression and treatment effectiveness.

Hepatitis C Treatment

Modern direct-acting antiviral drugs have revolutionized hepatitis C treatment, offering high cure rates with fewer side effects than older therapies. Treatment duration typically ranges from 8 to 12 weeks for most patients.

How effective are current hepatitis treatments? While hepatitis A resolves naturally, chronic hepatitis B can be effectively managed, and hepatitis C can be cured in most cases with proper treatment. Early diagnosis and intervention are crucial for optimal outcomes.

Long-Term Consequences of Chronic Hepatitis

Untreated chronic hepatitis B and C can lead to serious liver complications over time. Understanding these potential outcomes underscores the importance of early detection and treatment.

Potential Complications of Chronic Hepatitis

• Liver cirrhosis
• Liver failure
• Hepatocellular carcinoma (liver cancer)
• Portal hypertension
• Increased risk of other liver-related health issues

What steps can individuals with chronic hepatitis take to protect their liver health? Regular medical check-ups, adherence to prescribed treatments, avoiding alcohol, maintaining a healthy diet, and exercising regularly can help manage the condition and reduce the risk of complications.

Special Considerations for High-Risk Populations

Certain groups face higher risks of hepatitis infections or complications, requiring targeted prevention and screening efforts.

Vulnerable Populations for Hepatitis

• Intravenous drug users
• Men who have sex with men
• Healthcare workers
• Individuals of Asian descent (for hepatitis B)
• Baby boomers (for hepatitis C)
• Pregnant women
• People with HIV

How can healthcare providers better serve these high-risk groups? Implementing routine screening protocols, providing education on prevention strategies, and ensuring access to appropriate vaccines and treatments are crucial steps in addressing hepatitis in vulnerable populations.

Global Impact and Public Health Initiatives

Viral hepatitis remains a significant global health challenge, prompting various international initiatives to combat its spread and reduce its impact.

Key Global Hepatitis Initiatives

• World Health Organization’s Global Health Sector Strategy on Viral Hepatitis
• Universal vaccination programs for hepatitis B
• Efforts to improve access to hepatitis C treatments in low- and middle-income countries
• Public awareness campaigns to promote testing and prevention

What role do global health initiatives play in controlling hepatitis? These efforts are crucial in reducing new infections, improving access to testing and treatment, and working towards the ultimate goal of eliminating viral hepatitis as a public health threat.

Emerging Research and Future Prospects

The field of hepatitis research continues to evolve, with ongoing studies exploring new treatment options, improved diagnostic tools, and potential vaccines for hepatitis C.

Promising Areas of Hepatitis Research

• Development of a hepatitis C vaccine
• Novel therapies for drug-resistant hepatitis B
• Improved diagnostic techniques for early detection
• Strategies to eliminate mother-to-child transmission
• Innovative approaches to reach underserved populations

How might future advancements change the landscape of hepatitis management? Breakthroughs in these areas could lead to more effective prevention strategies, simpler treatment regimens, and potentially, the global eradication of viral hepatitis.

Understanding the nuances of hepatitis A, B, and C is crucial for effective prevention, early detection, and appropriate treatment. By recognizing the distinct characteristics of each virus, individuals can take proactive steps to protect their health and seek timely medical intervention when necessary. As research continues to advance, the outlook for managing and potentially eliminating these viral threats continues to improve, offering hope for a future with reduced hepatitis burden worldwide.

A Visual Guide to Hepatitis A, B, C

Medically Reviewed by Gabriela Pichardo, MD on September 05, 2021

Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it’s caused by a virus. This is known as viral hepatitis, and the most common forms are hepatitis A, B, and C.

Sometimes there are no symptoms of hepatitis in the first weeks after infection — the acute phase. But when they happen, the symptoms of types A, B, and C may include fatigue, nausea, poor appetite, belly pain, a mild fever, or yellow skin or eyes (jaundice). When hepatitis B and C become chronic, they may cause no symptoms for years. By the time there are any warning signs, the liver may already be damaged.

Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they’re sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.

It usually spreads through food or water. Food can be tainted when it’s touched by a person with hepatitis who did not wash their hands after using the bathroom. This transfers tiny amounts of infected stool to the food. Raw shellfish, fruits, vegetables, and undercooked foods are common culprits in hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren’t careful about washing hands after changing diapers.

A prime risk factor for hepatitis A is traveling to or living in a country with high infection rates. You can check the CDC’s travel advisories to learn about recent outbreaks. Eating raw foods or drinking tap water can raise your risk while traveling. Children who attend daycare centers also have a higher risk of getting hepatitis A.

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

You can get it through contact with the blood or body fluids of an infected person. In the U.S., it’s most often spread through unprotected sex. It’s also possible to get hepatitis B by sharing an infected person’s needles, razors, or toothbrush. And an infected mother can pass the virus to their baby during childbirth. Hepatitis B is not spread by hugging, sharing food, or coughing.

Anyone can get hepatitis B, but people who have multiple sex partners or inject illegal drugs have a higher risk. Other risk factors include being a health care worker who is exposed to blood, or living with someone who has chronic hepatitis B.

About 25% of people who get hepatitis C defeat the virus after a short-term infection. The rest will carry the virus in their body for the long term. Chronic hepatitis C can cause very serious complications, including liver failure and liver cancer. There are effective treatments for the virus, though. 

It spreads through infected blood. In the U.S., sharing needles or other items used to inject drugs is the most common cause of infection. Getting a tattoo or body piercing with an infected needle is another means of exposure. A mother may pass the virus to their child at birth. In rare cases, unprotected sex spreads hepatitis C, but the risk appears small. Having multiple sex partners, HIV, or rough sex seems to raise risk for spreading hepatitis C.

People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.

Chronic hepatitis can quietly attack the liver for years without causing any symptoms. Unless the infection is diagnosed, monitored, and treated, many of these people will eventually have serious liver damage. Fortunately, blood tests can determine whether you have viral hepatitis, and if so, which kind.

Testing is important for anyone with the risk factors we’ve mentioned, particularly injected drug users and people who have had multiple sex partners. Health advocates are also urging people of Asian heritage to get tested. Stanford University’s Asian Liver Center estimates that 1 in 10 Asians living in the U.S. has chronic hepatitis B. Many of them have probably had the virus since birth.

Also, the U.S. Preventive Services Task Force recommends that health care providers offer a one-time hepatitis C screening for anyone born between 1945 and 1965.   

If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.

Hepatitis A almost always goes away on its own, and no medication is needed. If nausea is a problem, try eating several small meals throughout the day instead of three large ones. Drink water, juice, or sports drinks to stay hydrated. And avoid hard exercise until you’re feeling better.

The goal of treating chronic hepatitis B is to control the virus and keep it from damaging the liver. This begins with regular monitoring for signs of liver disease. Antiviral medications may help, but not everyone can take them or needs to be on medication. Be sure to discuss the risks and benefits of antiviral therapy with your doctor.

The latest drug to be approved by the FDA is glecaprevir and pibrentasvir (Mavyret). This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.

There are several other combination drugs available, as well as some single drugs that may be used in combination. Your doctor will choose the right one for you depending on the type of hepatitis C you have, how well your liver is functioning and any other medical problems you may have. Also be sure to discuss your insurance coverage since these medications are expensive.

To manage chronic hepatitis B or C, your doctor will order regular blood tests to check how well your liver is working. Ultrasounds and CT scans can also reveal signs of damage. If the virus is not causing any liver problems, you may not need treatment. But it’s important to have regular tests to watch for changes. Complications are easiest to treat when found early.

One of the most common complications of chronic hepatitis is cirrhosis. This is a scarring of the liver that can be found with a biopsy. Cirrhosis makes it difficult for the liver to do its job and can lead to liver failure, a life-threatening condition. Symptoms include fatigue, nausea, weight loss, and swelling in the belly and legs. In severe cases, patients may experience jaundice and confusion.

Viral hepatitis is the top cause of liver cancer, so people with chronic hepatitis B or C need monitoring even if they feel healthy. Blood tests can detect proteins that suggest the presence of liver cancer. Ultrasounds, CT scans, and MRIs can reveal abnormal lesions in the liver (seen here in green). A biopsy is needed to determine if these areas are cancerous. Tumors that are found early may be surgically removed. But most liver cancers are difficult to treat.

The liver is a vital organ that aids in metabolism, digestion, detoxifying, and the production of many proteins needed by the body. If a large part of the liver is damaged beyond repair, it will no longer be able to perform these important jobs. People cannot live without a working liver. In this case, a liver transplant may be the best hope. This option provides the patient with a healthy liver from a donor.

There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.

If you have chronic hepatitis, there are steps you can take to keep your liver resilient. Avoid alcohol, which can cause additional liver damage. Check with your doctor before taking any medications or supplements, because some are tough on the liver or may not be safe in people with liver disease. Most importantly, keep your appointments for regular monitoring. By watching for any changes in your liver, you and your health care provider can stay one step ahead of the virus.

IMAGES PROVIDED BY:
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 23)   Image Source

SOURCES:

Allegheny General Hospital Liver Cancer Network.
American Cancer Society web site.
American Liver Foundation web site.
Centers for Disease Control and Prevention web site.
Hepatitis Foundation web site.
John W. Ward, MD, director, division of viral hepatitis, CDC, Atlanta.
Melissa Palmer, MD, clinical professor of medicine, New York University School of Medicine, New York City.
National Digestive Diseases Information Clearinghouse.
Pediatrics, published online Feb. 1, 2011.
The Nemours Foundation.
World Health Organization web site.
FDA. “FDA approves Mavyret for Hepatitis C.” “Mavyret Prescribing Information.”
Hepatitis C Online. “Hepatitis C Treatments.”

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Aspartate Aminotransferase (AST) Test Test Information

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Test Overview

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).

Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in 6 to 10 hours and remain high for about 4 days.

The AST test may be done at the same time as a test for alanine aminotransferase, or ALT. The ratio of AST to ALT sometimes can help determine whether the liver or another organ has been damaged. Both ALT and AST levels can test for liver damage.

Why It Is Done

This test is done to:

• Check for liver damage.
• Help look for liver disease, such as hepatitis. Liver disease may cause symptoms. These may include pain in the upper belly, nausea, vomiting, and sometimes jaundice.
• Check to see how well treatment for liver disease is working.
• Find out if jaundice was caused by a blood disorder or liver disease.
• Keep track of the effects of medicines that can damage the liver.

How To Prepare

In general, there’s nothing you have to do before this test, unless your doctor tells you to.

How It Is Done

A health professional uses a needle to take a blood sample, usually from the arm.

How long the test takes

The test will take a few minutes.

Watch

• Learning About Your Blood Test
• Learning About Blood Tests for Children

How It Feels

When a blood sample is taken, you may feel nothing at all from the needle. Or you might feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. When a blood sample is taken, a small bruise may form at the site.

Results

Each lab has a different range for what’s normal. Your lab report should show the range that your lab uses for each test. The normal range is just a guide. Your doctor will also look at your results based on your age, health, and other factors. A value that isn’t in the normal range may still be normal for you.

Results are usually available within 12 hours.

High values

High levels of AST may be caused by:

• Liver damage from conditions such as hepatitis or cirrhosis.
• A heart attack or heart failure.
• Many medicines, such as statins, antibiotics, chemotherapy, aspirin, opioids, and barbiturates.
• Very strenuous exercise or severe injury to a muscle.
• High doses of vitamin A.
• Kidney or lung damage.
• Mononucleosis.
• Some types of cancer.

Credits

alanine aminotransferase (ALT) in Moscow in the DNAOM laboratory

Alanine aminotransferase (ALT) is an intracellular enzyme from the group of aminotransferases, which plays one of the key roles in amino acid metabolism and providing cells with energy.

ALT catalyzes the transamination reaction between alanine and alpha-ketoglutarate.

The highest activity of ALT is detected in the liver and kidneys, the lower one – in the heart, skeletal muscles, pancreas, spleen, lungs, erythrocytes. The activity of the enzyme in the blood serum of women is somewhat lower than that of men. The content of ALT in the blood serum of healthy people is low, since the enzyme is located inside the cell. But when cells rich in ALT are damaged or destroyed, the enzyme is released into the bloodstream, which leads to an increase in its activity in the blood. Since the enzyme does not have organ specificity, the level of its serum activity does not always correlate with the severity of organ damage.

ALT for viral hepatitis
In viral hepatitis, the degree of increase in ALT activity is usually proportional to the severity of the disease. Despite a concomitant increase in transaminase levels in liver cell damage, ALT is a more specific marker of liver disease than ACT. In acute cases, the activity of the enzyme in the blood serum can exceed normal values ​​by 50–100 times or more. With viral hepatitis, an increase in enzyme activity occurs at a very early time – even before the appearance of jaundice in the prodromal period (it is noted in 50% of patients – in 5 days, in 90% – 2 days before the clinical manifestation of the disease). Enzyme activity is also increased in patients with the anicteric form of the disease. In dynamics, with a favorable course of the process, ALT activity slowly decreases to its original values ​​within a few weeks.

ALT in alcoholic hepatitis
Toxic hepatitis gives a picture similar to infectious hepatitis, with very high ALT and ACT values ​​in severe cases.

A more moderate increase in ALT activity is observed in alcoholic hepatitis. Transaminase levels in cirrhosis of the liver vary depending on the stage of the cirrhotic process, usually ranging from the upper limit of normal to 4-5-fold increase. A 5–10-fold increase in ALT and AST activity is observed in patients with primary or metastatic liver carcinomas (ACT higher than ALT), although transaminase levels may be within the normal range in the early stages of malignant infiltration of the organ.

ALT and myocardial infarction
In myocardial infarction, serum ALT increases to a much lesser extent than ACT, since the activity of ALT in cardiomyocytes is only a small part of the activity of ACT. In uncomplicated myocardial infarctions, ALT levels may be only mildly increased or within the normal range. An increase in serum ALT in myocardial infarction may indicate the development of congestion in the liver.

Readings:

• diagnostics of liver diseases;
• examination of contact persons in the focus of viral hepatitis;
• monitoring of patients with hepatitis of various etiologies;
• donor survey.

Preparation
It is recommended to donate blood in the morning, between 8 am and 11 am. Blood is taken on an empty stomach, after 6-8 hours of fasting. Drinking water without gas and sugar is allowed. On the eve of the examination, food overload should be avoided.

Interpretation of results
The ratio of AST/ALT activities is normally about 0.8-1, with enzymemia of hepatic origin (acute viral and toxic hepatitis) it can decrease to 0.2-0.5, with myocardial infarction – more than 1.1

Increased ALT values:

• acute and chronic liver diseases;
• acute and chronic pancreatitis;
• acute myocardial infarction, myocarditis;
• injury, skeletal muscle necrosis, myopathies, myositis;
• hemolytic diseases;
• thermal shock;
• renal failure.

Decrease in ALT values:

• deficiency B ₆ ;
• obstructive jaundice;
• end-stage renal failure.

How to increase leukocytes after chemotherapy: Blood test after chemotherapy: normal, interpretation

A blood test after chemotherapy worries the patient, but it is not the very fact of blood collection that frightens – it is always done in the same way and according to the laboratory standard, the possible result that determines the patient’s life for the next two weeks and the prospects for the next course of chemotherapy worries.

Women tolerate chemotherapy courses with more pronounced complications from the hematopoietic system, their leukocytes after chemotherapy and other blood cells usually decrease more. The male body reacts less to the toxicity of therapy, which has not yet been explained, and traditionally “turned the arrow” to sex hormones.

Often, a patient who is about to undergo a course of treatment is concerned about two questions: what blood parameters should not be treated with chemotherapy and how to restore the levels of blood cells after it. In this article, we will try to answer these questions in the most detailed and professional way.

Blood after chemotherapy

The use of most cytostatics adversely affects the patient’s hematopoiesis, some drugs kill more blood cells, some, like vinca alkaloids, almost do not change the analysis. For each antitumor drug, the percentage of the probability of a severe drop in leukocytes is determined, but the use of combinations of drugs, moreover, repeatedly over several weeks, sweeps aside all predictions for a favorable outcome – to undergo chemotherapy without loss of hematopoiesis.

Not all blood sprouts are equally damaged by cytostatics, leukocytes suffer most of all, not prepared by nature for a long life – their lifespan is a little less than two weeks, and therefore unstable to the vicissitudes of antitumor treatment.

Platelets live a little less, but an acceptable level is maintained by a large number – they are 30-40 times more than leukocytes. Thrombocytopenia – a decrease in the number of platelets below 150,000 develops with the use of a small number of cytostatics, for example, thiophosfamide, often begins with leukopenia, but the normalization of the number of platelets is delayed for several weeks after the completion of the chemotherapy cycle. The critical level of platelets is 32-34 thousand, when the risk of bleeding increases significantly.

Red blood cell – an erythrocyte should live for almost 120 days, only after 3-4 months a young cell will come out of the bone marrow to replace it, therefore it is more resistant to chemotherapy and 2-4 million of them circulate through the body. Anemia – a decrease in hemoglobin and the number of red blood cells is characteristic of a very small number of cytostatics, as a rule, several cycles of chemotherapy with platinum derivatives lead to it. The consequences of anemia are fatal – not only quality deteriorates, but life expectancy decreases and sensitivity to drug treatment changes, and in case of deep anemia, chemotherapy is contraindicated even to save life. The peculiarity of postchemotherapeutic anemia in the normal content of iron, that is, it is not iron deficient, is associated with insufficient reproduction of the red blood cell population.

The resistance of the erythrocyte membrane to external influences, including chemotherapy, determines the rate of their precipitation, which is checked by the erythrocyte sedimentation reaction in a test tube for 60 minutes – ESR . ESR increases with defects in red blood cells, chemotherapy can deform the erythrocyte, but it is the reproduction of blood cells in the bone marrow that suffers most from cytostatics. In most cases, ESR after chemotherapy does not change very much relative to the baseline and often parallel to the content of hemoglobin in the erythrocyte. Contrary to popular belief, ESR reacts little to the course of an oncological disease, but actively changes during inflammation or infection, which often accompanies a widespread malignant tumor. High ESR is often combined with anemia.

The most active leukocytes react to chemotherapy, consisting of five fractions: neutrophils, eosinophils, lymphocytes, monocytes and basophils. The most sensitive to cytostatics are neutrophils , in the blood test they are designated as stab and segmented leukocytes. Normally, there should be at least 1500 neutrophils, that is, at least half of all leukocytes, they are responsible for resisting immunity to inflammation and infection.

Fraction reduction lymphocytes , represented by the main immune defenders T-lymphocytes and immune memory cells B-lymphocytes, after chemotherapy are often not obvious and not as striking as neutrophils. Severe lymphopenia is characteristic of severe immune disorders, including HIV/AIDS. After chemotherapy, patients note a slight increase in the incidence of viral respiratory infections, but there have been no studies on the problem, it is not known how much the personal impression is true. It is assumed that with successful chemotherapy of a malignant tumor, immunity indicators only improve.

Thus, answering the question of how long it takes for blood to recover after chemotherapy, we can say that this is primarily determined by the rate of leukocyte recovery. Their level usually remains reduced for 1-2 weeks after completion of treatment, and then gradually increases.

Blood transaminases – ALT and AST do not reflect the effect of anticancer drugs on blood cell fractions, but the damaging effect of cytostatics and immuno-oncological drugs on the liver tissue. Chemotherapy drugs lead to toxic hepatitis, and immune anticancer drugs lead to autoimmune hepatitis. Hepatitis can be asymptomatic and manifested only by a change in the level of transaminases, and, depending on the severity of liver damage, ALT can increase three times and even more than 20 times the upper limit of normal.

How to increase white blood cells after chemotherapy?

Leukocytes, namely neutrophils, after chemotherapy can decrease to a critical level, which results in severe infections. A special form of a generalized inflammatory reaction after chemotherapy is febrile neutropenia, when nothing but a high temperature and a serious condition are found in the patient: there are no objective signs of sepsis, pneumonia, and inflammation of other organs. No pathological microflora is found in the blood test – everything is sterile, only neutrophils are less than normal, and the percentage may remain the same.

Neutropenia is divided into degrees as follows:

• the absolute number of cells is from one and a half thousand to a thousand, which does not exclude the development of febrile neutropenia after chemotherapy, that is, a single temperature increase of more than 38. 5℃ or twice in one day more than 38℃
• average degree from one thousand to 500 cells;
• severe neutropenia or agranulocytosis, that is, the absence of granulocytes – a drop in the level of neutrophils below 500.

So, how to raise neutrophils after chemotherapy? Stimulation of leukopoiesis is necessary only in case of febrile neutropenia, an asymptomatic decrease in the leukocyte fraction requires correction only in patients weakened by multiple chronic diseases.

The only effective drugs are colony-stimulating factors (CSF), there are several types of them, mainly aimed at stimulating white hematopoietic sprouts. The drugs activate an increase in the birth rate and the rate of maturation of neutrophils in the bone marrow; with the initial use of CSF in a blood test, the result is visible after a few hours.

No other drugs, except CSF, affect the reproduction of leukocytes, but only contribute to the rapid removal of deposited leukocytes from the bone marrow, depleting blood-forming resources. The number of representatives of white blood does not affect the patient’s diet and any procedures.

The use of hematopoietic stimulants is not only accompanied by unpleasant side effects, but also depletes bone marrow reserves over time, therefore strict indications are defined for CSF. CSF is never combined with chemotherapy, the drug is administered the next day after the cytostatic.

How to increase hemoglobin after chemotherapy?

Typically, anemia develops after multiple courses of chemotherapy and in most cases does not require urgent measures in the form of red cell transfusions, as is necessary for heavy bleeding.

According to the degree of severity, anemia can be:

• mild – hemoglobin at the level of 100-119 grams per liter, as a rule, it almost does not affect the state of health if the patient does not have a very common cancer process;
• medium degree with hemoglobin 80-99 g/l, the lack of oxygen carried into the tissues is manifested by a decrease in the functionality of the body, shortness of breath during physical exertion and weakness with rapid fatigue are possible;
• Anemia becomes severe when the hemoglobin level drops below 80 grams per liter of blood, mainly health suffers, but objective disorders of the organs of the cardiovascular system are also possible.

The level of hemoglobin is increased by injections of erythropoietins, treatment is started in severe cases. An increase in hemoglobin is noted after several months of treatment only in 60-70% of patients, erythropoietins are especially effective for anemia during chemotherapy with platinum derivatives.

Treatment of anemia is long-term – several months and often against the background of injections with iron preparations. There is no unequivocal understanding of whether erythropoiesis stimulants change the quality of life for the better, but the use of erythropoietin is also associated with side effects, especially unpleasant and dangerous – increased blood clotting with the formation of blood clots. Due to the likelihood of thrombosis, the stimulant is contraindicated in patients with limited motor activity and a history of thrombosis, and is not combined with CSF and some cytostatics.

How often should a blood test be done?

Not only is it important to do a blood test after chemotherapy, laboratory values ​​need to be monitored regularly during treatment. Blood tests – general with a leukocyte formula and platelets, as well as a detailed biochemical one, must be done before each cycle of chemotherapy. In a long cycle with weekly injections of drugs, the level of neutrophils should be checked on the eve of administration, because the level of leukocytes begins to decrease 7-10 days after the first injection of cytostatic.

The timing of the control blood test after chemotherapy is guided by the initial state and the combination of cytostatics used, that is, always individually, but no later than 5-7 days after completion of chemotherapy. Further control depends on the depth of neutropenia, daily monitoring of indicators is not excluded. When the level of leukocytes is normal, the next analysis is planned before starting chemotherapy.

How do I prepare for a blood test after chemotherapy?

For greater reliability of indicators, any blood test is taken on an empty stomach and is better in the morning after an 8-hour break for food. Before the analysis, you need to refrain from smoking for a couple of hours. Other restrictions are determined by the treating chemotherapist.

In a blood test, all indicators that deviate from the norm are important, because each reflects some kind of pathological changes in the body. Errors in the reliability of indicators are possible, but it must be taken into account that changes in the number of blood cells are not only daily, but also hourly, the bone marrow does not have lunch breaks and weekends, it works every second, giving birth to new cells and growing them for release into the bloodstream .

Fluctuations in biochemical parameters are more stable, as they reflect the state of organs and entire organ systems, so the study is done monthly, if there is no reason to look more often.

Now that we have looked at the follow-up examinations, it is important to answer one more question: what tests do not allow chemotherapy. The doctor must first check the patient’s blood counts.

Contraindications to chemotherapy

Antitumor treatment is inherently toxic — chemotherapy kills any cells, not all normal tissues are able to resist cytostatics. Many patients know about this and ask doctors what leukocytes can be treated with chemotherapy, what should be the indicators of erythrocytes and platelets. There are certain indications and contraindications.

In each clinical case, the time of administration of the chemotherapy drug and its dose is determined individually, based on many criteria. If we talk about what blood parameters are acceptable for chemotherapy, then formally treatment cannot be started at a leukocyte level below the standard leukocyte count for chemotherapy, but with neutrophils above 1500, there is not always a need to reduce a single dose of a chemotherapy drug. And with a lower level of neutrophils, it is possible to continue treatment, but with careful and regular monitoring of indicators and with the presence of CSF in the reserve.

In addition to the white blood cell count for chemotherapy, the number of other blood cells must also be taken into account. The lower limit of the start of chemotherapy for platelets is above 100 thousand, for hemoglobin – above 90 g / l, on an individual basis, these limits can be lowered with a change in the dose of cytostatic administered and the intervals between injections. Of course, the average degree of decline, and even more severe, is a contraindication for chemotherapy, but temporary – until recovery.

Of course, the veracity of indicators, especially in the process of antitumor treatment, depends on the available laboratory equipment and the quality of reagents, the speed of the study plays an important role. In our clinic, any study corresponds to the level of an expert opinion, otherwise our employees simply do not know how to work.

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References:

1. Lugovskaya S.