Liver biopsy in Irish hepatitis C-infected patients with inherited bleeding disorders

The majority of patients receiving plasma-derived clotting factor concentra tes between 1970s and the mid-1980s are now hepatitis C positive. The progr ession of hepatitis C is extremely variable and there is frequently a poor correlation among liver biochemistry, viral load and the stage of liver dis ease. Liver biopsy remains the only definitive way of staging fibrosis and grading necroinflammatory activity. Concerns have been expressed about the safety of the procedure: however, with modern regimes for the correction of coagulopathy in patients with inherited bleeding disorders, normal haemost asis may be maintained during the peribiopsy period. We performed 21 liver biopsies between 1984 and 1997 on patients with factor VIII (FVIII) or IX ( FIX) deficiency and von Willebrand's Disease (VWD). Four had concomitant hu man immunodeficiency virus (HIV) infection, five were thrombocytopenic and one had a prolonged prothrombin time (PT), Haemostasis was achieved using a n intermittent bolus of factor concentrate or continuous infusion regimens. One patient with VWD received Desmopressin (DDAVP). There were no bleeding episodes associated with biopsy. We suggest that liver biopsy is a safe pr ocedure in patients with inherited bleeding disorders when the coagulopathy is fully corrected. It is the only definitive method of staging the extent of fibrosis associated with hepatitis C infection, and it is this that def ines prognosis.