Patient suffering from HBV markers are as
follows:
1.Suffered from jaundice for 2months 2 yrs
back and examination revealed HBSAg+ve.
HBSAg+ve continues till now
2.HBVDNA-ve
3.HBeAg-ve
4.Liver function tests normal
What does these investigations indicate
and what shall be the future
possibility?
Jaundice (icterus) indicates that there is
too much bilirubin in the body. During
jaundice, the total amount of bilirubin
levels in the blood is increased
(hyperbilirubinemia). To define the term,
bilirubin is a pigment derived from the
metabolism of hemoglobin taken from old
and damaged erythrocytes. In this process,
old and damaged erythrocytes are first
captured by the cells of the
reticular-endothelial system (RES). Then,
the erythrocytes are placed in few organs
like spleen, liver, bone marrow, lymph
nodes etc. The hemoglobin (or more
precisely the part called the "hem")
transforms into indirect (non-conjugated)
bilirubin in the RES. In cases of
excessive destruction of erythrocytes
(hemolytic anemia), the level of indirect
bilirubin increases (hemolytic icterus).
Indirect bilirubin is transported to
the liver where the liver cells
(hepatocytes) transform the indirect
bilirubin into direct
bilirubin(conjugated) in a process known
as "conjugation". Direct bilirubin is then
excreted through the bile in to the
intestines. Bilirubin in the intestines
transforms into sterkobilin, a product
that gives the stool its color. Another
part of the intestinal bilirubin
transforms into urobilinogen which is
reabsorbed by the blood circulation and
transported back to the liver. In the
liver, urobilinogen transforms into direct
bilirubin and is excreted through the bile
again. This is called "enterohepatic
circulation". Another part of the
urobilinogen is excreted trough the
kidneys into the urine. In cases of
billiary obstruction (by tumor or stone),
direct bilirubin can’t be excreted into
the intestines (white stools) and instead,
it enters the bloodstream. High levels of
direct bilirubin in the blood manifests
with so called obstructive icterus. In
this case, direct bilirubin is also found
in the urine because this type of
bilirubin can pass through the kidneys.
That’s why the urine has a dark color
(bilirubinuria).
If the liver is damaged (hepatitis,
cirrhosis), blood levels of both types of
bilirubin (direct and indirect) will be
elevated because indirect bilirubin cannot
be transformed into direct bilirubin nor
can direct bilirubin be excreted into
intestines. This type of icterus is called
"hepatocelular icterus". Elevated levels
of enzymes are also found in the blood
which are derived from the damaged liver
cells (AST, ALT, alcal phosphatasa and
gama-GT). If liver damage is caused by
hepatitis-B, then HBs-Ag, HBV-DNA and
HBe-Ag will be also elevated.
In your case, it is possible to
confirm that you are carrier of the
hepatitis-B virus (HBV) because you have
positive result for HBs-Ag. Negative
results for HBV-DNA and HBc-Ag exclude
chronic infection with HBV. Normal liver
functional tests exclude the liver damage
as reason for the jaundice. You can
examine the blood levels of both types of
bilirubin to confirm jaundice. Blood count
with sedimentation, urine analyses and
abdominal ultrasound scan are also
necessary to explain the jaundice.
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