HBV Advocate Blog: A Simple Platelet Count Test Could Be Best Indicator of Fibrosis

Experts have been looking for years for a non-invasive, inexpensive test that can quickly and accurately indicate when patients have fibrosis. To date, a lot of lab tests have provided misleading information, according to a study published in the January issue of ISRN Gastroenterology.

For example, doctors used to think that normal ALT levels meant the liver was healthy and free of fibrosis or cirrhosis, but new studies show that 29% of hepatitis B patients with normal ALT levels have significant fibrosis. When doctors rely on ALT levels alone, fibrosis is missed and many patients who need treatment don't get it.

Researchers have also found no significant link between HBeAg status or viral load and liver fibrosis. Many patients become HBeAg-negative over time and develop lower viral loads as they age, which is often when fibrosis develops or worsens.

In this recent study, researchers performed biopsies on 157 patients and looked at their blood tests to see if there was some other lab test that consistently indicated when fibrosis was present. They examined albumin levels, prothrombin time, globulin, platelet counts, ALT levels and performed other tests that could alone or taken together provide a more accurate snapshot of when fibrosis was present.

Their study found that low platelet counts and albumin levels, especially in older patients, were accurate indicators of significant fibrosis.

Platelets help the blood clot and are smaller than red or white blood cells. Albumin, made by the liver, helps move small molecules through the blood, including bilirubin, calcium, progesterone, and medications.

"In conclusion, ALT is a poor marker when considering antiviral therapy because of its poor correlation with significant liver injury in patients with chronic HBV infection," they wrote. "Lower levels of platelet count were independently associated with significant fibrosis. If a liver biopsy is considered to assess disease activity and fibrosis, it can be recommended for patients with chronic HBV infection, particularly for an older age group and patients with normal ALT and lower platelet count and albumin."