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Modified Hepatic Activity Index

Modified HAI Grading: Necroinflammatory Scores
Periportal or Periseptal Interface Hepatitis (piecemeal necrosis) (A)	Score	Confluent Necrosis (B)	Score	Focal (spotty) Lytic Necrosis, Apoptosis, and Focal Inflammation* (C)	Score	Portal Inflammation (D)	Score
Absent	0	Absent	0	Absent	0	None	0
Mild (focal, few portal areas)	1	Focal confluent necrosis	1	One focus or less per 10x objective	1	Mild, some or all portal areas	1
Mild/moderate (focal, most portal areas)	2	Zone 3 necrosis in some areas	2	Two to four foci per 10x objective	2	Moderate, some or all portal areas	2
Moderate (continuous around <50% of tracts or septa)	3	Zone 3 necrosis in most areas	3	Five to ten foci per 10x objective	3	Moderate/marked, all portal areas	3
Severe (continuous around >50% of tracts or septa)	4	Zone 3 necrosis + occasional portal-central (P-C) bridging	4	More than ten foci per 10x objective	4	Marked, all portal areas	4
		Zone 3 necrosis + multiple P-C bridging	5	References Ishak K, et al. Histological grading and staging of chronic hepatitis. J Hepato/1995;22:696-699. Knodell RG, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5
		Modified Staging Chart	Scoring Chart
Panacinar or multiacinar necrosis	6
	Total Modified HAI = __/18
Does not include diffuse sinusoidal infiltration by inflammatory cells.
Additional features which should be noted but not scored: Bile Duct inflammation & damage Lymphoid Follicles Steatosis, mild, moderate or marked Hepatocellular dysplasia, small or large cell Adenomatous hyperplasia Iron or copper overload Intracellular inclusions				Immunohistochemical findings: Information on viral antigens, lymphocyte subsets or other features, when available, should be recorded and may be semi-quantitatively expressed