title: Percutaneous liver biopsy in hemophiliac children with chronic hepatitis C virus infection.
abstract: OBJECTIVE
  To develop a protocol for safe performance of percutaneous liver biopsies in children with deficiency of factor VIII (n = 12) or IX (n = 2) and chronic hepatitis C virus infection.
  
  
  METHODS
  Liver biopsies were performed after administration of factor VIII or IX, before and 24 weeks after cessation of antiviral therapy. To define the optimal means of providing replacement therapy, 10 children were enrolled in a randomized crossover design study of bolus versus continuous factor VIII for performance of the liver biopsy. For the crossover study, all of the patients were given a loading dose of 50 +/- 5 IU recombinant factor (rF)VIII/kg; a minimum of factor VIII activity of > or = 80% 30 to 60 minutes following factor VIII infusion was required for liver biopsy. For the bolus protocol, rFVIII 25 to 50 IU/kg was given 6, 14, 24, 36, 48, and 60 hours after completion of the loading dose. For the continuous protocol, rFVIII was given 3 to 4 IU/kg per hour for 48 hours, followed by a bolus of 25 IU/kg at 60 hours. In patients with factor IX deficiency, a loading dose of 100 IU/kg was followed by a bolus of 50 IU/kg at 3, 15, 27, and 48 hours after the loading dose.
  
  
  RESULTS
  Twenty liver biopsies were performed in children with factor VIII deficiency without major complications. One of the 3 biopsies in the patients with factor IX deficiency was complicated by a hemoperitoneum. Midazolam and fentanyl were used in the first 8 patients. However, postbiopsy pain, presumably secondary to hematoma in 2 patients and hemoperitoneum in 1, prompted us to use ultrasound to locate a suitable biopsy site and to change to propofol; this allowed us to better immobilize the liver, to minimize postbiopsy bleeding. The subsequent 15 biopsies were well tolerated without postbiopsy pain or other complication.
  
  
  CONCLUSIONS
  Percutaneous liver biopsy in children with factor VIII deficiency can be safely performed using either bolus or continuous infusion of recombinant factor VIII. A brief general anesthetic and ultrasound guidance are recommended.
authors: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. kschwarz@jhmi.edu
authors: Kathleen B
authors: KB
authors: Schwarz
authors: Aglaia
authors: A
authors: Zellos
authors: Lisette
authors: L
authors: Stamato
authors: John
authors: J
authors: Boitnott
authors: Elizabeth
authors: E
authors: Perlman
authors: Sonny
authors: S
authors: Chong
authors: James F
authors: JF
authors: Casella
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D018592:Cross-Over Studies; D005164:Factor IX / Q000008:administration & dosage; D005169:Factor VIII / Q000008:administration & dosage; D006406:Hematoma / Q000209:etiology; D006465:Hemoperitoneum / Q000209:etiology; D006467:Hemophilia A / Q000150:complications* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications; D012449:Safety; D016896:Treatment Outcome
chemical_list: D005169:Factor VIII; D005164:Factor IX