Американский Научный Журнал SEROLOGICAL METHODS IN THE DIAGNOSIS OF LIVER FIBROSIS IN PREGNANT WOMEN WITH HEPATITIS B, C AND EVALUATION OF THE SENSITIVITY AND SPECIFICITY OF SWE ELASTOGRAPHY ()

B, C virus hepatitis being the leading cause of acute and chronic liver disease, causes 1,4 million deaths every year. Currently, 248 million people worldwide live with chronic HBV infection, and 110 million people are positive for HCV-antibodies (in 80 million of them an active viremic infections are found) (1) According to the American College Obstetricians and Gynaecologist (FAQ-Pregnancy 093, November, 2013), chronic HBV infection can lead to complications such as liver cirrhosis, liver cancer and premature death. Infected infants are at high risk (up to 90%) for viral transmission.(2) They also transmit the virus to others and in 25% of cases they die because of liver cirrhosis or liver cancer at reaching adulthood. Hepatitis C also has similar complications, such as Hepatitis B. Chronicity of these diseases contributes to the development of fibrosis in the liver. In scientific sources of recent years (2018), there are reports on chronicity of the disease during pregnancy and deepening of fibrosis in the liver. (3) Скачать в формате PDF
8 American Scientific Journal № (34) / 20 20
МЕДИЦИНА И СТОМАТОЛО ГИЯ

SEROLOGICAL METHODS IN THE DIAGNOSIS OF LIVER FIBROSIS IN PREGNANT WOMEN
WITH HE PATITIS B, C AND EVA LUATION OF THE SENSI TIVITY AND SPECIFICITY OF SWE
ELASTOGRAPHY

Ellada Sariyeva Goshgar
PhD in Medicine
Ismay ıl Gafarov Adil
PhD in Physics and Mathematics
Azerbaijan Medical University, II Department of Obstetrics and Gynaecology, Bak u
Azerbaijan Medical University Department of Medical and Biological Physics,
Baku
Baku city, phone: +994 70 816 35 56
Baku city, phone : +994 50 339 97 96

Urgency . B, C virus hepatitis being the leading
cause of acute and chronic liver disease, cause s 1,4
million deaths every year. Currently, 248 million
people worldwide live with chronic HBV infection, and
110 million people are positive for HCV -antibodies (in
80 m illion of them an active viremic infections are
found) (1) According to the American Co llege
Obstetricians and Gynaecologist (FAQ -Pregnancy 093,
November, 2013), chronic HBV infection can lead to
complications such as liver cirrhosis, liver cancer and
prem ature death. Infected infants are at high risk (up to
90%) for viral transmission.(2) T hey also transmit the
virus to others and in 25% of cases they die because of
liver cirrhosis or liver cancer at reaching adulthood.
Hepatitis C also has similar complic ations, such as
Hepatitis B. Chronicity of these diseases contributes to
the developmen t of fibrosis in the liver. In scientific
sources of recent years (2018), there are reports on
chronicity of the disease during pregnancy and
deepening of fibrosis in th e liver. (3)
There are various methods in the diagnosis of liver
fibrosis, and biopsy i s considered the "gold standard"
among them. However, because the method is invasive,
its use in pregnant women is limited. The rapid
development of biological medicine in recent years has
led to the use of non-invasive serological tests in blood
in the di agnosis of liver fibrosis (serum haptoglobin,
serological analysis of AST / ALT), and SWE
elastography that detects focal lesion in the liver. (4)
Haptoglobin is a major plasma protein that is
mainly synthesized in livers and rarely in the lungs, fat
tissues, skin, and kidneys. The main function of
haptoglobin is to unite and remove the free
haemoglobin, which is released as a result of
intravascular or extravasc ular haemolysis, from body,
thereby having an antioxidant role in the body. (5 , 6, 7)
Haptoglobin -haemoglobin complex is a stable complex
and has high affinity. (8) Scientific sources have
reported the importance of the determination of
haptoglobin in the blood as a major non -invasive serum
indicator of hepatic fibrosis in patients with hepatitis B
and C. Haptoglobin is a key c omponent of the FIBRO
test used in the diagnosis of liver fibrosis. (9,10)
Increasing of levels of alanine aminotransferase
and aspartate aminotransferase, the major enzymes of
liver in hepatitis B, C, in particular determination of
Retis Index-AAN (AST/AL T) ratio as an indicator of
liver fibrosis include diagnostic non -invasive methods.
(11)
During our study of scientific sources, no
scientific research was found in pregnant women with
chronic B, C hepatitis that study blood haptoglobulin
(Hp), alaninaminotransferase (ALT), aspartate
aminotransferase (AST), serum albumin, C -reactive
protein (CRP), a nd SWE elastography of liver in
comprehensive and comparative way, on specificity
and sensitivity of these methods in the diagnosis of
hepatic fibrosis during pregnancy. No scientific
research has been carried out in this area in the
Republic of Azerbaijan either.
Objective of the study : to clarify the role of
serum Hp, ALT, AST, serum albumin as serum
biomarkers of liver fibrosis in pregnant women with
chronic B, C virus hepatitis, and as well as to evaluate
the serological methods shown in the diagnosis of liver
fibrosis and the specificity and sensitivity of the SWE
elastography of liver. For this purpose, a comparative
analysis of non-invasive serolo gical methods and SWE
elastography of the liver was performed with specific
mathematical-statistical metho ds in infected pregnant
women.
Object and methods of research : Scientific
research work was conducted at the II Department of
Obstetrics and Gynaecology at the Azerbaijan Medical
University, Baku, Azerbaijan. The research was based
on the collected material for 2016-2018. This scientific
work has been approved by the Ethics Committee of
Azerbaijan Medical University. The focus of the study
was 100 pregn ant women with chronic B, C virus
hepatitis in the age group of 18 -45 years, and test group
consisted of 5 0 practically healthy pregnant women.
Pregnant patients with genital and extragenital
infections, severe preeclampsia, and haemolytic
pathologies were not included in the group. Pregnant
women in the study group were identical to their
pregnancy and parity . Diagnostics of viral hepatitis (B,
C) were performed by Express Card, immune -enzyme
analysis (Automated Biochemical ECLIA Analyzer -
Cobas 4000 e411 ), and Quantitative and Qualitative
analysis of HBV, HCV was performed by PZR
Reaction (Real Time PZR Dete ction Systems). PZR-
1IU = 4.5 copies for hepatitis B virus; PZR -1IU = 2,5
ASJ (2) / 2020

American Scientific Journal № ( 34) / 20 20 9

copies for Hepatitis C virus (National Institute of
Biological Standards an d Hepatitis B Control for
NIBSC WHO International Standard: 97/746) 2,5 ml
blood samples were taken from e lbow veins for PZR
analyzes. The amount of haptoglobins in the blood
serum was performed by immunoturbidimetric
analysis. (The human haptoglobin cause s a precipitate
in reaction with a specific antiserum).
Immunoturbidimetric analysis (Roshe Company) is
based on the principle of immunological agglutination.
Blood samples for biochemical analyzes were obtained
from elbow veins in the amount of 3 ml after morning
starvation. Two reagents were used during the
laboratory analysis: R1 -phosphate buffer: 12,7 mmol /
l, pH 7,2; NaCL: 130 mmol / l; PEQ: 40g/l,
preservative; R2 reagent: antibody taken from rabbit
blood against human haptoglobin. Blood was
centrifuged and plasma removed, placed in a test bottle
containing Li -heparin and K₂ -EDTA. Determination of
haptog lobins in blood serum, liver enzymes, serum
albumin, and CRZ in blood was performed on a
biochemical automated analyzer of Roche -Hitachi
Cobas 4000 c3 11 (c 501/502) - (USA) by
immunoturbidimetric method. (12,13,14)
Scientific literature provides very littl e
information on the level of serum haptoglobins during
pregnancy. (15)
The liver density in pregnant women was studied
by Shear Wave Elastography, S WE elastography of the
liver in pregnant women was performed at the
Supersonic Aixplorer multi-Wave (Franc e) device at
the AMU Educational Surgery Clinic. The examination
was conducted in a left -leaning position lying on the
back. The ultrasonic transmitte r is located in the VIII-
IX hypochondrium area, along the right and front
axillary lines. The stiffness of the tissue was measured
2 cm below the liver capsule in the non -vascular area
of the right liver lobe. The results were evaluated
according to the ME TAVIR scale. (16) Statistical methods
: Variance, dispersion (F -
Fisher), discriminant (χ2 -Pearson Chi Squa re), and
correlation analysis (ρ -Spearman) were used in the
course of the study. Statistical analyzes were performed
in the MS EXCEL -2013 spreadsheet and in the SPSS-
20 statistical package software. “O” hypothesis was
rejected when p≤0,050 was in statistic al analyzes.
An ROC curve is set on the sensitivity and
specificity indicators. The ROC curve (receiver
operating characteristic) indicates the dependence of
the number of cases correctly diagnosed (positive) in
the binary classification on the number of i naccurate
(negative) cases. The numerical evaluation of the ROC
is measured by the area below the curve. The ideal ROC
curve has a Г -shaped form . When the characteristic
curve is close to the ideal graphics, the studied method
is considered effective.
Results of the study : 150 pregnant women were
included in the study object. The studied pregnant
women were divided into 3 groups: I group - control
group (n = 50). The control group was made up of
practically healthy pregnant women. II group - HBV -
positive pr egnant women (n = 55), III group - HCV -
positive pregnant women (n = 45). Only monocyesis
pregnant women were included in the study. There
were n o smokers or alcohol -addicted women in the
study group. Demographic data and clinical
characteristics of patient s indicated that all pregnant
women were Azerbaijani. The average age of the
control group was 26,7 ± 0,6; in the main group it was
28,8 ± 0,5 years. BKI in practical healthy pregnant
women was 24,5 ± 0,5 kg/m²; in the main group, 25,7
± 0,3 kg/m² (it shou ld be noted that BKI in pregnant
women was calculated based on pre -pregnancy weight
gain in the second trimester of pregnancy). The clinical
cha racteristics of the groups under study for other
indicators are given in Tables 1,2,3,4.
Table 1
Crosstab
Gro ups Total Control HBV and HCV
Rh
Rh - Count 8 9 17
% within group 16,0% 9,0% 11,3%
Rh + Count 42 91 133
% within group 84,0% 91,0% 88,7%
Total Count 50 100 150
% within group 100,0% 100,0% 100,0%

Chi -Square Tests
Value Df Asymp. Sig. (2 -sided) Exact Sig. (2 -sided) Exact Sig. (1 -sided)
Pearson Chi -Square 1,625 a 1 ,202
Continuity Correction b 1,003 1 ,316
Likelihood Ratio 1,554 1 ,213
Fisher's Exact Test ,274 ,158
Linear -by-Linear Association 1,615 1 ,204
N of Valid Cases 150
a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 5,67.
b. Computed only for a 2x2 table

ASJ (2) / 2020

10 American Scientific Journal № (34) / 20 20
Table 2
Crosstab
Groups Total Control HBV and HCV
Blood groups
O(I) Count 13 37 50
% within group 26,0% 37,0% 33,3%
A(II) Count 18 33 51
% within group 36,0% 33,0% 34,0%
B(III) Count 10 20 30
% within group 20,0% 20,0% 20,0%
AB(IV) Count 9 10 19
% within group 18,0% 10,0% 12,7%
Total Count 50 100 150
% within group 100,0% 100,0% 100,0%
Chi -Square Tests
Value Df Asymp. Sig. (2 -sided)
Pearson Chi -Square 2,982 a 3 ,394
Likelihood Ratio 2,947 3 ,400
Linear -by-Linear Association 2,354 1 ,125
N of Valid Cases 150
a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 6,33.

Table 3
Crosstab
Group Total Control HBV and HCV
Count of
pregnancies
First
pregnancy
Count 32 42 74
% within group 64,0% 42,0% 49,3%
Multiple
pregnancy
Count 18 58 76
% within group 36,0% 58,0% 50,7%
Total Count 50 100 150
% within group 100,0% 100,0% 100,0%

Chi -Square Tests
Value Df Asymp. Sig. (2-
sided)
Exact Sig. (2 -
sided)
Exact Sig. (1 -
sided)
Pearson Chi -Square 6,454 a 1 ,011
Continuity Correction b 5,604 1 ,018
Likelihood Ratio 6,517 1 ,011
Fisher's Exact Test ,015 ,009
Linear -by-Linear Association 6,411 1 ,011
N of Valid Cases 150
a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 24,67.
b. Computed only for a 2x2 table

Table 4
Crosstab
Group Total Control HBV a nd HCV
Paritet
Nulliparous
women
Count 39 58 97
% within group 78,0% 58,0% 64,7%

Multiparous
women
Count 11 42 53
% within group 22,0% 42,0% 35,3%
Total Count 50 100 150
% within group 100,0% 100,0% 100,0%


ASJ (1) / 2020ASJ (2) / 2020

American Scientific Journal № ( 34) / 20 20 11

Chi -Square Tests
Value Df Asymp. Sig. (2 -
sided)
Exact Sig. (2 -
sided)
Exact Sig. (1-
sided)
Pearson Chi -Square 5,835 a 1 ,016
Continuity Correction b 4,993 1 ,025
Likelihood Ratio 6,097 1 ,014
Fisher's Exact Test ,019 ,012
Linear -by-Linear Association 5,797 1 ,016
N of Valid Cases 150
a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 17,67.
b. Computed only for a 2x2 table

In infected pregnant women the average of ALT,
AST enzymes was respectfully 27,5 ± 2,5 U / l (range
6 -187) (pF = 0,026); 32,0 ± 2,6 U / l (range 3-194) (pF
= 0,016) (in control group – 19,5 ± 0,7 U / l (range 11 -
28); 22,9 ± 0,5U / l (range 16 -28). However, it should
be noted that in 89% of pregnant women with chronic
parenteral hepatitis, ALT remained unchanged and in
8 3% AST level remained unchang ed, and only ALT
increase was observed in 11,0 ± 3,1% and an increase
in AST at 17,0 ± 3.8%.
However, different types of viremia have been
detected in the blood. According to the results of study,
virological examination of the blood of pregnant
women with HBV in 14 patients (25,5 ± 5,9%) was
PZR negative, in 20 patients (36,4 ± 6,5%) the burden of the virus was <2000 IU / ml, in 21 pregnant (38, 2 ±
6,6%) the viral load was> 2000 IU / ml. In 9 (20,0 ±
6,0%) pregnant women with HCV infection, PZR was
negati ve; in 14 persons (31,1±6,9%) the burden of the
virus was <4 x10⁵ IU/ ml, in 6 pregnant women
(13,3±5,1%) it was 4 x10⁵ IU/ml - 8x10⁵ IU / ml; in 16
pregnant women (35,6 ± 7.1%), the quantity index of
the virus in blood was> 8x 10⁵ IU / ml.
On our part, the level of haptoglobin in the blood
was comparatively studied in practically healthy
pregnant women and women with chronic HBV and
HCV. The results of the study showed that the level of
haptoglobin in the blood of pregnant women with HBV
and HCV was 1,2 tim es higher than in practically
healthy pregnant women (Fp = 0,049) (Fig.1).


Figure 1. The level of haptoglobulin

It is known from scientific sources that
haptoglobin may increase blood levels in inflammatory
processes such as acute phase protein. It is even
believed that haptoglobulin plays an
immunomodulatory role in the pathogenesis of
inflammatory diseases. (17)

On our part, we evaluated the correlation with HP
and CRP, the primary inflammatory mediator in the
blood, in order to study the role of haptoglobin as an
inflammatory mediator or a fibrosis biomarker.
Mathematical and statistical calculations revealed tha t
positive correlation between HP and CRP was found (ρ
= 0,273; ρ = 0,006) (Fig.2).

ASJ (1) / 2020ASJ (2) / 2020

12 American Scientific Journal № (34) / 20 20


A study of liver densi ty in parenteral hepatitis
pregnant women with SWE elastography revealed that
liver density in the main group was 1,6 times higher
than in the control group (Fp = 0,009). It should be
noted that comparisons between the main group and the
control group on t his indicator revealed that the liver
density in the HCV group increased 1,8 times (Fp =
0,017) compared to the test group (1,5p) in the HBV
group (Fp < 0,001).
On our part, the sensitivity and specificity of
serological biomarkers (ALT, AST, haptoglobin) and
liver SWE elastography in the diagnosis of liver
fibrosis in pregnant women with chronic B, C hepatitis
were studied by ROC analysis. Statistic calculation
showed that a correctness of integrity indicators of
specificity and sensitivity for ALT was p = 0,073; for
AST was p = 0,058 in examined groups in diagnostics,
which was not statistically correct (Fig.3). However,
integral indicators of sensitivity and specificity for
albumin were statistically correct (p<0,001) (Fig.4).

ROC ALT AST by group1
ROC Curve
Case Processing Summary
Group Valid N (listwise)
Positive 98
Negative 50
Missing 2

ASJ (2) / 2020

American Scientific Journal № ( 34) / 20 20 13


Figure 3. The sensitivity and specificity of ALT, AST

Area Under the Curve
Test Result Variable(s) Area Std. Error Asymptotic Sig.
Asymptotic 95% Confide nce
Interval
Lower Bound Upper Bound
Alt ,590 ,046 ,073 ,501 ,680
Ast ,596 ,046 ,058 ,506 ,685

ROC Albumin BY group1
ROC Curve

Case Processing Summary
Group Valid N (listwise)
Positive 100
Negative 50

ASJ (2) / 2020

14 American Scientific Journal № (34) / 20 20



Area Under the Curve
Test Result Variable(s): Albumin
Area Std. Error Asymptotic Sig. Asymptotic 95% Confidence Interval
Lower Bound Upper Bound
,211 ,037 ,000 ,138 ,284

Mathematical and statistical analyzes showed that
integral indicators of sensitivity and specificity of
seru m haptoglobin in the setting of hepatic fibrosis in
pregnant women were not statistically reliable (p = 0,085). However, integral indicators of sensitivity and
specificity of the figure s obtained from SWE
elastography were statistically correct (p <0,001).
(Fig.5)

ROC Haptoglobin Fibrosis by group1
ROC Curve
Case Processing Summary
Group Valid N (listwise)
Positive 100
Negative 50

Figure 4. The sensi tivity and s pecificity of albumin
ASJ (2) / 2020

American Scientific Journal № ( 34) / 20 20 15


Figure 5. ROC curves for serum haptoglobin and SWE elastography

Area Under the Curve
Test Result Variable(s) Area Std. Error Asymptotic Sig.
Asymptotic 95% Confidence
Interval
Lower Bound Upper Bound
Haptoglobulin ,586 ,047 ,085 ,495 ,678
SWE (fibrosis) ,885 ,027 ,000 ,833 ,938

Discussion:
The study found that ALT, AST, and serum
haptoglobin in pregnant women wi th hepatitis B, C
were not the most effective method for detecting liver
fibrosis. However, serum substances in the detection of
hepatic fibrosis in non -preg nant patients with hepatitis
B and C are an integral part of diagnostic tests. Serum
haptoglobin ha s become more informative as an
indicator of inflammatory process in pregnant women
with parenteral hepatitis, which is the object of our
study. Our results coincide with those of other authors.
Some researchers believe that plasma haptoglobin
levels are i ncreased threefold if there are inflammatory
processes in the absence of hemolysis in the blood. (18
) Recent scientific studies have revealed a positive
cor relation of haptoglobin with IL -6 and IL -8 in
inflammatory processes and severe chronic lung
diseas e. (19)
The determination of serum albumin in infected
pregnant women and SWE elastography of the liver has
been shown to be highly effective as diagnostic
methods for the detection of liver fibrosis. Studies by
Fontane H. et al have shown that chronic he patitis C
infection has a negative effect on liver tissue during
pregnancy: 25% of non -pregnant women and 83,3% of
pregnant women have signs of necro -inflamm atory process in the liver, respectively, signs of fibrosis were
found in the liver in 8,3% of non -pregnant women and
41,6% of infected pregnant women.(20)
Conclusion: Thus, serum albumin and SWE
elastography have high sensitivity and specificity in the
d iagnosis of hepatic fibrosis in pregnant women with
hepatitis B, C. It is advisable to use these ex amination
methods as non -invasive methods in the diagnosis of
hepatic fibrosis in pregnant women infected with
parenteral (B, C) hepatitis.
LITERATURE
1. WHO. In WHO guidelines on hepatitis B and C
testing. Geneva: World Health Organization; 2017.
Licence : CC BY -NC -SA 3.0 IGO WHO Guidelines
Approved by the Guidelines Review Committee (
February,2017)
2. The American College Obstetricians and
Gynecologyst. (FAQ -Pregnancy 093,November,2013)
3. Tatyana Kushner , Norah A. Terrault Hepatitis
C in Preg nancy: A Unique Opportunity to Improve the
Hepatitis C Cascade of Care Journal Hepatol Commun.
2019 Jan; 3(1): 20 –28. Publishe d online 2018 Nov
30. doi: 10.1002/hep4.1282
ASJ (2) / 2020

16 American Scientific Journal № (34) / 20 20
4. Ferraioli G, Wong VW, C astera L, Berzigotti A,
Sporea I, Dietrich CF, Choi BI, Wilson SR, Kudo M,
Barr RG.
Liver Ultrasound Elastography: An Update to th e
World Federation for Ultrasound in Medicine and
Biology Guidelines and Recommendations.
Ultrasound Med Biol. 2018 Dec;44(1 2):2419-
2440. doi: 10.1016/j.ultrasmedbio.2018.07.008
5. Rabea Asleh ,Shany Blum , Nina S. Levy et al.
Haptoglobin: Basic and Cli nical Aspects . Journal
Antioxidants Redox Signaling. 2010 Feb;12(2):293-
304. doi: 10.1089/ars.2009.2793
6. Andersen CBF , Stødkilde K , Sæderup
KL , Kuhlee A , Raunser S , Graversen JH , Moestrup
SK , Haptoglobin Journal Antioxidants Redox Signal ing
.2017 May 10;26(14):814 -831. doi:
10.1089/ars.2016.6793. Epub 2016 Nov 8.
7. Jamal Sarvari , Zahra Mojtahedi , Yas uhiro
Kuramitsu , Seyed -Ali Malek -Hosseini, Mahmoud
Shamsi Shahrabadi , Abbas Ghaderi , and Kazuyuki
Nakamura , Differential expression of haptoglobin
isoforms in chronic active hepatitis, cirrhosis and HCC
related to HBV infection Oncol Lett. 2011 Sep 1; 2(5):
871– 877. Published online 2011 May
31. doi: 10.3892/ol.2011.321
8. Marianne Jensby Nielsen , Christian Brix
Folsted Andersen and Søren Kragh Moestrup CD163
Binding to Haptoglobin -Hemoglobin Complexes
Involves a Dual -point Electrostatic Receptor -Ligand
Pairing Journal of Biological Chemistry 2013: 288:
18834 -18841.
9. Rafie Yakoob , Issam Al Bozom , Ragesh Babu
Thanda ssery, Mohamed Osman Abdel
Rahman ,Moutaz F. Derbala , Muneera J. Al
Mohannadi , Anil K. John , Manik Sharma ,Hamidulla
Wani , Saad Al Kaabi Noninvasive biomarkers
FibroTest and ActiTest vers us liver biopsy in chronic
hepatitis C patients: the Middle East experience Ann
Gastroenterol. 2015 Apr-Jun; 28(2): 265– 270.
PMC4367218
10. World Health Organization, GUIDELINES
FOR THE PREVENTION, CARE AND
TREATMENT OF PERSONS WITH CHRONIC
HEPATITIS B INF ECTION. MARCH 2015
11. Pathik Parikh, John D. Ryan, Emmanuel A.
Tsochatzis, Fibrosis assessment in patients with
chronic hepatitis B virus (HBV) infection, J.Annals of
Translational Medicine 2017; 5 (3); 40.p.1 -14
12. Dati F, Schumann G, Thomas L, et al.
C onsensus of a group of professional societies and
diagnostic companies on guidelines for interi m
reference ranges for 14 proteins in serum based on the
standardization against the IFCC/BCR/CAP Reference
Material (CRM 470). International Federation of Clinical Chemistry. Community Bureau of Reference
of the Commission of the European Communities.
Col lege of American Pathologists. European journal of
clinical chemistry and clinical biochemistry: journal of
the Forum of European Clinical Chemistry Societies
1996;34:517‐20.)
13. Blirup -Jensen S Protein standardiza tion III:
Method optimization basic principles for quantitative
determination of human serum proteins on automated
instruments based on turbidimetry or nephelometry.
Clin Chem Lab Med. 2001 Nov;39(11):1098 -109 :
DOI: 10.1515/CCLM.2001.175
14. Qu ality of Diagnostic Samples
Recommendations of the Working group on
preanalytical quality of the German United Society for
Clinical Chemistry and Laboratory Medicine, 3 rd
completely revised edition 2010 (W.G.Guder, F. da
Fonseca -Wollh eim, W. Heil, Y. Schm itt, G. Töpfer, H.
Wisser , B. Zawta), 77p.
15. ANDERS LARSSON , MARIA PALM ,
LARS‐OLOF HANSSON , SAMAR BASU Reference
values for α
1‐acid glycoprotein, α 1‐antitrypsin,
albumin, haptoglobin, C‐reactive protein, IgA, IgG and
IgM during pregnancy Acta Obstet Gynecol
Scand. 2008;87(10):1084 -
8. doi:
10.1080/00016340802428146 .
16. Zachary D. Goodman Grading and staging
systems for inflammation and fibrosis in chronic liver
diseases, Journal of Hepatology 2007; vol.47 (4) p.
598- 607. Doi: org/10.16/j.j. hep.2007.07.006
17. Isaak K. Quaye Haptoglobin, inflammation and
disease. Transactions of T he Royal Society of Tropical
Medicine and Hygiene , Volume 102, Issue 8, August
2008, Pages 735 –
742, https://doi.org/10.1016/j.trstmh.2008.04.010
18. Körmöczi GF , Säem ann MD , Buchta C , Peck -
Radosavljevic M , Mayr WR, Schwartz DW, Dunkler
D , Spitzauer S , Panzer S . Influence of clinical factors
on the haemolysis marker haptoglobin. European
Journal of Clinical Investigation. 2006 Mar;36(3):202 -
9. Doi.org/10.1111/j.1365 -2362.2006.01617.x
19. Pao-Lin Lee , Kang -Yun Lee , Tsai -Mu
Cheng , Hsiao -C hi Chuang , Sheng -Ming Wu , Po -Hao
Feng , Wen -Te Liu , Kuan -Yuan Chen , Shu -Chuan Ho
Relationships of Haptoglobin Phenot ypes with
Systemic Inflammation and the Severity of Chronic
Obstructive Pulmonary Disease J.Scientific Reports
2019. Volume 9, Article number: 189 .p.1 -8
DOI:10.1038/s41598 -018- 37406 -9
20. Fontaine H , Nalpas B , Carnot F , Bréchot
C , Pol S . Effect of pregnancy on chronic hepatitis C: a
case -control study. Lancet. 2000 Oct
14;356(9238):1328 -9. Doi: 10.1016/S 0140-
6736(00)02823 -3 .
ASJ (2) / 2020