‘Les liaisons dangereuses’: Hepatitis C, Rituximab and B-cell non-Hodgkin’s lymphomas

Table 1 Clinical significance of commonly performed biochemical liver tests

Liver test	Clinical significance
AST, ALT	Cytolysis
Total bilirubin, γGT, ALP	Cholestasis
Prothrombin time/INR, Albumin, pCHE	Synthesis
Decreased platelet number	Portal hypertension

AST: Aspartate-aminotransferase; ALT: Alanine aminotransferase; γGT: γ-glutamyl transpeptidase; ALP: Alkaline phosphatase; INR: International normalized ratio; pCHE: Pseudo-cholinesterase.

Table 2 Liver ultrasound: information for the management of liver diseases

Parenchymal signs
Dimensions	Hepatomegaly
	Caudate lobe hypertrophy
	Quadrate lobe hypotrophy
Echo pattern	Coarse: typical of liver fibrosis
	Coarse nodular: micronodular cirrhosis
	Attenuation sign/bright liver: typical of hepatic steatosis
Nodules	Benign vs malignant lesions
	Skip areas (fatty liver)
Surface	Nodular vs smooth
Extraparenchymal signs
Indirect signs of portal hypertension	Splenomegaly
	Ascites
	Collateral vessels
	Lack of splenic and/or superior mesenteric vein diameter variations during breathing
	Increased portal vein diameter
Doppler ultrasound	Inversion/reduction of portal vein flow
	Portal vein thrombosis/cavernomatosis

Table 3 Patterns of drug induced liver disease according to laboratory tests

Pattern	ALT	ALP	ALT/ALP
Hepatitis pattern	≥ 3 ULN	--	≥ 5 ULN
Cholestatic pattern	--	≥ 2 ULN	≤ 2 ULN
Mixed pattern	> 3 ULN	> 2 ULN	> 2 ULN to < 5 ULN

ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; ULN: Upper limit of normal. Adapted from Verma et al[56].

Table 4 Mild, moderate and marked elevations of serum liver enzymes

Enzyme	Mild	Moderate	Marked
sAT	> 2-3	2, 3-20	> 20
ALP	< 1.5.2	1.5-5	> 5
γGT	> 2-3	2-3-10	> 10

Numbers are times (X) upper limit of normal value. sAT: Serum aminotransferases; ALP: Alkaline phosphatase; γGT: γ-glutamiltranspeptidase. Adapted from Ahmed et al[57].