Therefore, for the effective use of serum AFP measurements in risk assessment, these variables need to be taken into account which can be achieved by standardizing the measured levels into multiples of the normal … Unexplained elevation in maternal serum alpha-fetoprotein and subsequent fetal loss. AFP is the major glycoprotein of fetal serum and resembles albumin in molecular weight, amino acid sequence, and immunologic characteristics. Dr. Corey Bosin answered. A high level of AFP can be an indication of a neural tube defect such as spina bifida. Accurate and satisfactory interpretation of MSAFP screening should be emphasized in the establishment of a well-developed normal median value. In healthy adults, AFP is present in extremely low levels. See Triple Screen for interpretation; Fetal serum AFP: Peaks at 3 mg/ml at 13 weeks High levels of AFP may mean other cancers, including Hodgkin disease, lymphoma, and renal cell carcinoma (kidney cancer). Send thanks to the doctor. An AFP test causes no health risk to you or the fetus. 35 AF specimens from 33 confirmed neural tube defective pregnancies were assayed for AFP. 0 AFP is elevated in about 80 percent of hepatocellular carcinoma cases, often to levels well above 1,000 ng/ml. .C…ÆûµJ*l3œ…&Ì:SQãb$uNI�§5¬§æ‘¢À‰X�ã`nˆ“â One pregnancy with suspicious ultrasound findings had an amniotic fluid AFP value at the upper third standard deviation line, which is below the level … 1 thank. 48 0 obj <> endobj NIH MoM value of 1.00 is average. AFP is present in the fluid around the fetus (amniotic fluid) and a small amount crosses the placenta and moves into the mother's blood stream. If your results show lower than normal AFP levels, it may mean your baby has a genetic disorder such as Down syndrome, a condition that causes intellectual and developmental problems. AFP goes through the placenta into the mother's blood.  |  Serum alpha-fetoprotein (AFP) levels were monitored in 32 normal babies consecutively from 2 to 3 days, 2 wk, and 2 and 4 months after birth. AFP is more than double the normal value. It is found in the fluid surrounding the baby in the womb (amniotic fluid). Here are some more facts to help you decide if you want to have the test. Results … Likewise, hCG in a Down syndrome pregnancy would be greater than 1.0 MoM. Table II shows the median of the maternal serum markers levels. The AFP level in fetal serum reaches a peak of 3 mg/mL at 13 to 15 menstrual weeks. Clipboard, Search History, and several other advanced features are temporarily unavailable. The number is not a diagnosis, but definitely is cause for alarm and my dr has scheduled a full … One of these is the alpha-fetoprotein (AFP) test that can detect any fetal abnormalities around 18 weeks of pregnancy. Amniotic fluid AFP and acetylcholinesterase concentrations can be used to differentiate between open ventral wall defects (gastroschisis and omphalocele) and open neural tube defects. The percentage of fetal deaths associated with maternal alpha-fetoprotein levels at least 2.0 times the median was 12.2 percent (17 of 139) between 20 and 23 weeks … 2.5 is considered high. The baby's intestines are outside the abdomen (belly). 0. The AFP gene is located on the q arm of chromosome 4 (4q25). The concentration of AFP peaks in fetal serum between 10 to 13 weeks. In order to establish a normal MSAFP median value at our own laboratory, 5256 samples of MSAFP were collected from uncomplicated, singleton pregnant women between 13 and 24 weeks' gestation. Listed in this appendix are pediatric normal ranges for some of the more common hematology and chemistry tests along with the references from which they were obtained. Pregnancy symptoms during week 13. An AFP test can only point to possible problems with the fetus. Normal adult values are less than 40 micrograms (mg) per liter. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Maternal serum alpha-fetoprotein (MSAFP) screening has been widely used and proven valuable in the prediction of a variety of fetal disorders. Fetal plasma concentration increases to a maximum (approximately 3.0-4.0 g/L) between 13-14 weeks of gestation. … Maternal and amniotic fluid AFP levels are clinically relevant in ante- A low PAPP-A means that the concentration of maternal serum PAPP-A is less than 0.5 MoM between 11 and 13 weeks of pregnancy. The AFP test may be performed between the 14th and 22nd weeks of pregnancy, however, it seems to be most accurate during the 16th to 18th week. The two hormones hCG and PAPP-A levels are measured during the combined screening test of PAPP-A levels, around 12 weeks of pregnancy, are represented through their MoM value and concentration (IU/L). The AFP gene is located on the q arm of chromosome 4 (4q25). Synthesis of AFP occurs primarily in the liver and yolk sac of the fetus. In the serum screening, the lab reports all results in either this way or as a total risk factor calculated by a software program." An AFP test can warn you about some fetal birth defects. 2009 Jul;145(1):57-64. doi: 10.1016/j.ejogrb.2009.04.017. 0 comment. The AFP test may be performed between the 14th and 22nd weeks of pregnancy, however, it seems to be most accurate during the 16th to 18th week. (Ç The risk of complications during pregnancy increase in case of low PAPP-A levels. Eur J Obstet Gynecol Reprod Biol. When I was 17 weeks I was told my afp levels were low, with a 1:142 chance of Downs and I'm only 23.. when I went for genetic counseling/ level 2 ultrasound they didn't find any soft markers for Down Syndrome and the doctor reduced my RISK to 1: 300 something and highly recommended that I did not have an amnio done. Alpha-fetoprotein (AFP, α-fetoprotein; also sometimes called alpha-1-fetoprotein, alpha-fetoglobulin, or alpha fetal protein) is a protein that in humans is encoded by the AFP gene. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. hCG levels in early pregnancy are at their highest towards the end of the first trimester, before they gradually decline over the rest of the pregnancy. The high AFP levels associated with a tumor should return to normal following successful treatment, with rising levels after treatment indicating new tumor growth or recurrence. Midtrimester human chorionic gonadotropin levels: normal reference values in Chinese pregnant women. AFP levels, A comparison of the levels of AFP in the fetal serum (FS), amnlotic fluid (AF), and maternal serum (MS| throughout pregnancy. Any laboratory intending to provide MSAFP screening needs to establish its own reference data. %PDF-1.5 %âãÏÓ An AFP test can only point to possible problems with the fetus. NT at 11–13 weeks’ gestation. Low levels of hCG may be detected in a woman’s blood 8-11 days after conception. After birth, maternal and infant AFP rapidly decline. The normal range for each week is presented. Alpha-fetoprotein (AFP) is a protein that is normally produced by the fetus' liver. The American Pregnancy Association says that all pregnant women should be offered an AFP test sometime between the 15th and 20th week of pregnancy. It is secreted in fetal serum, reaching a peak at approximately 13 weeks gestation, after which it rapidly declines until about 22 weeks gestation and then gradually declines until term. All pregnancies tested were normal. USA.gov. Then fall in long-linear fashion until 25 weeks. Amniotic fluid AFP and acetylcholinesterase concentrations can be used to differentiate between open ventral wall defects (gastroschisis and omphalocele) and open neural tube defects.  |  In Australia, an ultrasound scan at 18-20 weeks if often done instead of AFP tests. (Depending the number of markers used, the test may … 11–13 weeks: 53 (35–70) 43: 26 (18–35) 32: 32 (25–40) 35: 24 (20–29) 27: 19/36: 30/117: 49/153: 81/335: 19–24 weeks: 53 (28–77) 60: 45 (29–62) 39: 47 (34–61) 44: 29 (22–37) 27: 9/17: 17/38: 26/55: 47/162: FPR = 10%: 11–13 weeks: 67 (49–81) 54: 40 (31–50) 45: 46 (38–55) 47: 36 (30–41) 37: 24/36: 47/117: 71/153: 119/335: 19–24 weeks: 71 (44–90) 72: 58 … Is elevated maternal serum alpha-fetoprotein in the second trimester of pregnancy associated with increased preterm birth risk? We examined the effect of add-ing AFP on the performance of screening by the combined test. Negative Pregnancy Adult: < 15 ng/mL or < 15 µg/liter; Pregnancy Trimester One: 18 to 119 ng/mL or 18 to 119 µg/liter ; Pregnancy Trimester Two: 96 to 302 ng/mL or 96 to 302 µg/liter; Pregnancy Trimester Three: 160 to 550 ng/mL or … Test: Age: Range: Units: Red Cell Count: 0-1 month 1-2 months 2-3 months 3-6 months 6 months-1 year: 3.90-5.90 3.10-5.30 2.70-4.50 3.10-5.10 3.90-5.50: millions/mm3: Hematocrit: 0-1 month 1-2 … If AFP levels are not normal, it means that more tests should be done to determine the cause. In the infant serum AFP levels rapidly decline postnatally. Increased levels of AFP in prenatal blood test can be an indication of open neural tube defect and Down syndrome. An increase is a signal that something may be wrong. Next week marks the beginning of your second trimester, when many women see early pregnancy symptoms such as morning sickness and fatigue subside.More good news: Many women also notice a distinct increase in their sex drive around this time.. Making colostrum 35 AF specimens from 33 confirmed neural tube defective pregnancies were assayed for AFP. There are two categories of AFP tests: tests performed on serum (blood plasma), and tests performed on amniotic fluid.Tests performed on serum are further categorized by the reason for performing the test: maternal serum, adult tumor marker, and pediatric tumor marker. Fetal levels subsequently fall to the range of 17,200-44,350 ng/ml (mean 30,875 ng/ml) in the term baby [14,15]. AFP concentration in amniotic fluid follows a curve similar to that of fetal serum, but at a 150-fold dilution. Pregnant women with PAPP-A level lower than 0.5 MoM need constant monitoring as they are believed to be at a higher risk of having If AFP levels after cancer treatment do not significantly decrease, usually to normal or near normal levels, then some of the tumor tissue may still be present. An AFP level between 10 ng/mL to 20 ng/mL is normal for adults. COVID-19 is an emerging, rapidly evolving situation. Predicting pregnancy outcome from the degree of maternal serum alpha-fetoprotein elevation. AFP is a protein normally made by the baby’s liver. Elevated alpha-fetoprotein refers to a state where alpha-fetoprotein levels are outside of the reference range.. Open NTD Screening with AFP • ONTD in direct contact with amniotic fluid – AF-AFP increases followed by MS-AFP • Ideal screening time is 16 -18 weeks – AFP MoM distributions of affected and unaffected are maximally different – Sufficient time for follow-up tests • Can be done at 15-22 weeks Your levels of AFP vary during pregnancy so accurate pregnancy dating is imperative for more reliable screening results. In normal pregnancy, serum AFP concentration is affected by gestational age and maternal ... Gestational age was determined by the measurement of fetal crown–rump length at 11–13 weeks or the fetal head circumference at 19–24 weeks 20, 21. Alpha-fetoprotein (AFP) testing is used to screen for a NTD during the second trimester of pregnancy. Of which, 965 patients were excluded due to the following reasons: 446 patients had pre-treatment and post-treatment serum AFP levels within the normal range of 0–20 ng/mL, 282 patients had a delayed AFP measurement following treatment (more than 8 weeks), and 237 patients demonstrated early progression of HCC within 8 weeks of completing treatment. PIP: A steady decline in alpha fetoprotein (AFP) levels was observed in single specimens of amniotic fluid (AF) from 237 patients, ranging from 26 mcg/ml at 7-9 weeks to 155 ng/ml at term. As the baby grows and produces more AFP, the amount in the mother's blood increases.Between weeks 15 and 20 of a pregnancy, a maternal serum alpha-fetoprotein (MSAFP) screen may be offered. Here are some more facts to help you decide if you want to have the test. One of these is the alpha-fetoprotein (AFP) test that can detect any fetal abnormalities around 18 weeks of pregnancy. 101 0 obj <>stream Normal Value Range. A typical normal range is 0.5 to 2.0 or 2.5 MoM. Post-treatment reduction in AFP levels were significant in patients who underwent resection (p < 0.001), liver transplantation (p = 0.002), radiofrequency ablation (RFA), percutaneous ethanol … This is the diagnostic use of AFP as a tumor marker. Your levels of AFP vary during pregnancy so accurate pregnancy dating is imperative for more reliable screening results. An abnormal AFP is when it is >2.5 mom. Pregnancy and laboratory studies: a reference table for clinicians. This raises my chances that the baby may have spina bifida, or another neuro-tubal defect. AFP concentration in amniotic fluid follows a curve similar to that of fetal serum, but at a 150-fold dilution. An … Between 15 and 20 weeks' gestation, the mother may be given the option to have a maternal serum screening test for Down syndrome and open neural tube defects, such as spina bifida.Included in the screening panel are tests for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol, and sometimes inhibin A.  |  AFP is typically part of the triple screen or quad screen test (along with human chorionic gonadotropin or HCG, estriol, and inhibin A) … Obstet Gynecol. Around 6 month treatment, He feels good as before. Higher than normal AFP levels in the blood of the mother may mean: The baby's brain is not developing (neural tube defects). Alpha-fetoprotein screening is a blood test that checks the level of alpha-fetoprotein in the mothers' blood during pregnancy. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. By the age of 2 years the infants of this study had not reached adult serum AFP levels (0-6 ng/ml). fßM×. hŞb```f``Jg`e`ñeb@ ! There are quite a few diagnostic tests and screenings that you will have to undergo during the course of your pregnancy. In patients with liver cancer and abnormal AFP levels, the Alpha-FetoProtein test is used as a marker in respond to the treatment. Between day 180 and 720 of life, AFP levels up to 87 ng/ml were within the 95.5% interval (assumed logarithmic normal distribution) with a mean of 8 ng/ml without a further decline. Ideally it takes place between 16 and 18 weeks of gestation but between 15 and 22 weeks is acceptable. Doctors measure AFP in your blood in nanograms per milliliter (ng/mL). 13 weeks pregnant symptoms By the 13th week, you’ll notice your earlier symptoms begin to fade and may find yourself in a comfortable state before fully entering your second trimester. 1995 Sep;18(3):240-7. NLM All pregnancies tested were normal. (Depending the number of … If successfully the liver cancer is eliminated surgically, then the AFP proportion is expected to reduce to normal. Serum levels of AFP, free-β-hCG and uE3 in the second trimester maternal serum. However, since AFP can be increased in hepatitis or cirrhosis, AFP levels can sometimes be misleading. Usually its levels fall soon after birth. Read on to know about the alpha-fetoprotein normal range and what it means if levels are higher or lower. This site needs JavaScript to work properly. Cusick W, Rodis JF, Vintzileos AM, Albini SM, McMahon M, Campbell WA. See Triple Screen for interpretation; Fetal serum AFP: Peaks at 3 mg/ml at 13 weeks Fetal AFP diffuses across the placental barrier into the … He started PD-1 treatment late of June and the AFP decreased after 3 IV infusion (once/2 weeks). Yes: An AFP at 15 weeks that was 1.3 mom is normal. A typical normal range is 0.5 to 2.0 or 2.5 MoM. Synthesis of AFP occurs primarily in the liver and yolk sac of the fetus. Am i within a normal range or am i too high/too low? AFP is a glycoprotein with a molecular weight of 68000 daltons produced by the fetal yolk sac and fetal liver. Maher JE, Davis RO, Goldenberg RL, Boots LR, DuBard MB. However, high levels of AFP can also indicate that the mother is further along in her pregnancy than realized and her due date needs to be recalculated. CT and MRI scan in Nov, the tumor shrink more than 50%. The baby may have physical defects such as dwarfism (DWORF-izm). About 2.5 percent of all women screened will fall into the screen positive group, and about one in 25 of these will have an affected pregnancy. Results: In the tri somy 21 pregnancies, the median mul-tiple of the normal median AFP, adjusted for gestational age, maternal weight, racial origin, smoking status and method AFPA : Alpha-fetoprotein (AFP) is a single polypeptide chain glycoprotein with a molecular weight of approximately 70,000 Da. Poor prognosis if AFP > 10,000 ng/ml at diagnosis; AFP >10,000 associated with 50% five year survival; Normal pregnancy. What Is the Normal PAPP-A Level? Median serum AFP levels were 319.6 ng/mL at baseline and 49.6 ng/mL, 4–8 weeks following the initial treatment of HCC, and this decrease in AFP levels was significant (p < 0.001). A systematic review and meta-analysis. High AFP could mean you're further along than you thought, because your level keeps going up throughout your pregnancy. Only very low levels of the protein are present in healthy children and adults, except for pregnant women. In normal pregnancy, serum AFP concentration is affected by gestational age and maternal characteristics, including maternal weight, racial origin and cigarette smoking12–18. It's usually as part of a set of tests, which screen fo… tional week [13]; maternal serum AFP levels are highest in the 32nd gesta- tional week. Measuring other markers (e.g., estriol and chorionic gonadotropins) enhances aneuploidy screening. Table II shows the median of the maternal serum markers levels. AFPA : Alpha-fetoprotein (AFP) is a single polypeptide chain glycoprotein with a molecular weight of approximately 70,000 Da. An AFP test causes no health risk to you or the fetus. Alpha-fetoprotein (AFP, α-fetoprotein; also sometimes called alpha-1-fetoprotein, alpha-fetoglobulin, or alpha fetal protein) is a protein that in humans is encoded by the AFP gene. A high AFP could also mean the mother is carrying twins, according to Kaiser Permanente. Women with a raised AFP level (at least two times the normal median) are interpreted as screen positive and offered further tests. HHS Is This an Emergency? Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities. Normal AFP <5.4 ng/ml (5.4 ug/L) AFP >500 ng/ml unlikely to be from benign cause; Nonseminomatous germ cell tumor. The AFP level in fetal serum reaches a peak of 3 mg/mL at 13 to 15 weeks of gestation. Serum levels of AFP, free-β-hCG and uE3 in the second trimester maternal serum. Poor prognosis if AFP > 10,000 ng/ml at diagnosis; AFP >10,000 associated with 50% five year survival; Normal pregnancy. Fetal levels subsequently fall to the range of 17,200-44,350 ng/ml (mean 30,875 ng/ml) in the term baby [14,15]. The normal level for most healthy adults is between 0 and 8 ng/mL. Changgeng Yi Xue Za Zhi. View chapter Purchase book In healthy adults, AFP is present in extremely low levels. Further, fetuses with autosomal trisomies 13, 18, 21 detected as a result of high MS-AFP often have sonographically detectable structural abnormalities. Raised levels of maternal AFP at 16-18 weeks of gestation are found in fetal neural tube defects.  4Sƒ ��TJk``vq’覊2°|:¤%€Xd0#Cç‡^“Wö0”I0ä_ğn³‘6ÈØhêÊ$~Aø�¨ÛÆ An AFP test can warn you about some fetal birth defects. Raised levels of maternal AFP at 16-18 weeks of gestation are found in fetal neural tube defects. There was a progressive rise of AFP levels from week 7 onwards, but a clear separation from non-pregnant values was only apparent after 8 weeks. … In the infant serum AFP levels rapidly decline postnatally. Most AFP tests now also include testing of two or three more markers, says Dr Harold N. Bass of the Department of Genetics at Kaiser Permanente Medical Center in Panorama City, California. Down syndrome pregnancies have lower levels of AFP and estriol, so their levels would be below the average, and therefore less than 1.0 MOM. Diagnosis: Before 14 weeks AFP helps to diagnose neural tube defects. The normal level for most healthy adults is between 0 and 8 ng/mL. Maternal serum alphafetoprotein was assayed in 436 women presenting for termination of pregnancy at 6 to 12 weeks. The concentration of AFP in fetal blood is 100,000 times greater than it is in maternal blood. There are quite a few diagnostic tests and screenings that you will have to undergo during the course of your pregnancy. The AFP at 8th week is very high, then there is a dip at 11 weeks and again peak at 13 weeks. Hematology. During pregnancy, AFP tests may be done to find or watch defects in the developing fetus. Maternal serum levels peak at about 30 weeks (about 250 mg/L). I am double the high range. Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities. Normal range is .5-2.0. 74 0 obj <>/Filter/FlateDecode/ID[<0A57BFA97D3DD07250A398CE5192CE41>]/Index[48 54]/Info 47 0 R/Length 112/Prev 333740/Root 49 0 R/Size 102/Type/XRef/W[1 2 1]>>stream My 17 week blood work came back and everything was normal except my AFP levels (Alpha-Fetoprotein) were at a 5. Written informed consent was obtained from the women agreeing to participate in a study on adverse pregnancy outcome, … In order to establish a normal MSAFP median value at our own laboratory, 5256 samples of MSAFP were collected from uncomplicated, singleton pregnant women between 13 and 24 weeks' gestation. By the end of the first trimester, nearly all of the AFP is produced by the fetal liver. In addition, serum AFP concentration was also measured in 116 random specimens from infants with normal liver enzymes and 10 infants born immaturely. Alpha-fetoprotein, or AFP, is a protein found normally in abundance in the developing fetus. MAFP1 : Alpha-fetoprotein (AFP) is a fetal protein that is initially produced in the fetal yolk sac and liver. In the first 4 weeks of life, AFP levels decreased by 50% in 5.1 days in term babies. High-resolution ultrasound can find this defect. 1. It is secreted in fetal serum, reaching a peak at approximately 13 weeks gestation, after which it rapidly declines until about 22 weeks gestation and then gradually declines until term. The MSAFP median levels steadily rise with advancing gestation about 16% per gestational week in average. Between 15 and 20 weeks' gestation, the mother may be given the option to have a maternal serum screening test for Down syndrome and open neural tube defects, such as spina bifida.Included in the screening panel are tests for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol, and sometimes inhibin A. The MSAFP median levels steadily rise with advancing gestation about 16% per gestational week in average. If you are … (Reprinted with permission.41 ter amniocentesis revealed an increased amni- otic fluid AFP. There were 0.17% and 4.4% of the pregnancies with serum AFP levels … No worries! A 30-year-old female asked: Hi! PIP: A steady decline in alpha fetoprotein (AFP) levels was observed in single specimens of amniotic fluid (AF) from 237 patients, ranging from 26 mcg/ml at 7-9 weeks to 155 ng/ml at term. Read on to know about the alpha-fetoprotein normal range and what it means if levels are higher or lower. Maternal and amniotic fluid AFP levels are clinically relevant in ante- Normal adult values are less than 40 micrograms (mg) per liter. A small amount is produced by the gastrointestinal tract. A low level of AFP can be an indication of genetic defects such as a higher risk of Down Syndrome (Trisomy 21) or Trisomy 18, a more severe and less common chromosomal anomaly. I am 16 weeks pregnant, age 30, 127lbs, and my AFP levels from a blood test came at 31 ng/ml. If your AFP levels are not normal, it doesn't necessarily mean there is a problem with your baby. The MSAFP median levels steadily rise with advancing gestation about 16% per gestational week in average. 2009 Dec;114(6):1326-1331. doi: 10.1097/AOG.0b013e3181c2bde8. tional week [13]; maternal serum AFP levels are highest in the 32nd gesta- tional week. 13 June, 2017 . in Normal Pregnancy at 11–13 Weeks’ Gestation Foteini E. Bredaki a David Wright c ... the maternal serum level of AFP is reduced not only in the second trimester but also in the first trimester and it is possible that measurement of serum AFP may improve the performance of the combined test at 11–13 weeks [11] . Elevated blood levels of AFP can be associated with liver disease, certain kinds of cancer and abnormal pregnancies. Please enable it to take advantage of the complete set of features! If your AFP levels begin to increase, then it is likely that the cancer is recurring. Would you like email updates of new search results? hŞbbd``b`V�@‚‘ HpÍŠÇ�Ód Ágc‰|)©ì uÌ ½& ®ˆ{ Äš$Ønƒ÷H¯ˆˆ)�"@†Z¾ טöƒ\ÀÀ8`ĦÇÏ Çñ† hCG levels can vary at different times of the day, and from week to week. An extremely high level of AFP in your blood—greater than 400 ng/mL—could be a sign of liver tumors. In Australia, an ultrasound scan at 18-20 weeks if often done instead of AFP tests. fetal disorders the South Australian Maternal Serum Antenatal Screening (SAMSAS) Programme measures th Very high levels of AFP were found in 13/14 fluids examined before Week … Your baby may make more AFP than normal, or … %%EOF MoM means multiple of the median or average of all the tests. endstream endobj startxref Epub 2009 May 19. His highest AFP level was 68,0000 during the treatment and now AFP is 11.8. 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