Liver Biopsy
FOR IRON OVERLOAD
Liver biopsy provides direct information about the structure, function, and extent of iron deposition within the liver, and may also have prognostic value.
Advantages of liver biopsy
Liver biopsy provides the most quantitatively accurate, sensitive, and specific test for liver iron concentration (LIC), and can be used to accurately estimate body iron burden. The test also allows for direct evaluation of non-heme liver storage iron, as well as histochemical examination of differential accumulation in hepatocytes and Kupffer cells. The test also provides insight into liver tissue histology and pathology through assessments of inflammation, fibrosis, and cirrhosis. Liver biopsy is the method of choice in the research community for assessing total body iron.
Disadvantages of liver biopsy
Liver biopsy is an invasive and painful procedure, and carries the risk of bleeding and infection, as well as damage to the liver or surrounding organs. Fatal complications have been reported, but these are rare (1,2). The safety of liver biopsy is enhanced by ultrasound guidance; a complication rate of 0.5% was reported in one large study (3). Sampling errors, especially in the cases of cirrhosis or low weight sample sizes, have been reported (4). Liver iron concentration is poorly correlated with cardiac iron deposition.
Heterogeneity of iron distribution in a cirrhotic liver
Heterogeneity of iron distribution in a cirrhotic liver
Substantial variability of LIC values seen in a cirrhotic liver. Image used with permission of Yves Deugnier and Bruno Turlin, Liver Unit & Department of Pathology, CHU Pontchaillou, Rennes, France.
Prognostic value of LIC
Studies have demonstrated the prognostic value of liver iron concentration in both transfusional and hereditary iron overload. Patients with thalassemia major who had an LIC above ~ 15 mg Fe/g of liver dry weight (dw) had a higher risk of cardiac complications and early death than those whose LIC was below this threshold,(5) suggesting the clinical value of a "critical LIC" value. Threshold levels for hepatocellular injury(6) and fibrosis or cirrhosis are above LIC levels of approximately 22.0 mg Fe/g dw (7). Critical LIC may also be used to guide iron chelation therapy.
Critical LIC Levels
Critical LIC values >15 mg Fe/g dw predict increased risk of cardiac disease (5). Above about 22 mg Fe/g dw, fibrosis or cirrhosis is common (7).
Learn about treatment of iron overload
Email
Print
Iron and Hepatic Damage
The development of liver fibrosis
directly correlates
to liver iron concentrations and serum ferritin levels.
References
- * (1)Otobe Y, Hashimoto T, Shimizu Y, et al, Formation of a fatal arterioportal fistula following needle liver biopsy in a child with a living-related liver transplant: report of a case. Surg Today. 1995;25(10):916-9.
- * (2) Drinkovic I, Brkljacic B, Two cases of lethal complications following ultrasound-guided percutaneous fine-needle biopsy of the liver. Cardiovasc Intervent Radiol. 1996;19(5):360-3.
- * (3)Angelucci E, Baronciani D, Lucarelli G, et al, Needle liver biopsy in thalassaemia: analyses of diagnostic accuracy and safety in 1184 consecutive biopsies. Br J Haematol. 1995;89(4):757-61.
- * (4)Porter JB, Practical management of iron overload. Br J Haematol. 2001;115(2):239-52.
- * (5) Brittenham GM, Griffith PM, Nienhuis AW, et al, Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994;331(9):567-73.
- * (6) Jensen PD, Jensen FT, Christensen T, et al, Relationship between hepatocellular injury and transfusional iron overload prior to and during iron chelation with desferrioxamine: a study in adult patients with acquired anemias. Blood. 2003;101(1):91-6.
- * (7)Bassett ML, Halliday JW, Powell LW, Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis. Hepatology. 1986;6(1):24-9.