Re: Liver Enzymes

scowlns@xxxxxxxxx wrote:
I am a recovering cocaine addict, light to moderate past use. I have
been sober for a while now. At a recent doctor visit they did blood
work and discovered my atl was at 684 they said 80 was normal. My DR is
baffled. Im a 25m can anyone with knowlege please tell me what this
means. Ive been tested for hepititaus and it was negative. Ive never
done any IV drugs and I have had 3 blood transfusions in 2001.

If viral hepatitis testing was undertaken then I would assume that a
hepatic blood panel was also done which would include a repeat ALT.
Viral hepatitis usually is in the one to four times upper reference of
normal range for like Hepatitis C. IT is not unheard of to have 50-100X
upper limits of normal.

Most cases of chronic cell necrosis involves less than 7 times the
normal of tranaminases.
In this case it is almost X9 which is close to acute cell hepatic
necrosis. Acute cell necrosis usually involves a virus, toxin, alcohol
or ischemia. Chronic necrosis is usually associated with a low albumin
level and in chronic active hepatitis or cirrhosis with an elevated
globulin level. Autoimmune hepatitis and primary biliary cirrhosis
would also require additional testing such as an ANA, smooth muscle
antibody, and type I liver-kidney microsomal antibody. Some of the
other conditions were already mentioned such as Wilson's disease and
alpha one antitrypsin deficiency.

The alkaline phosphatase is important in further characterizing the
condition in terms of necrotic vs cholestatic. An ALK greater than 300
indicates cholestatic jaundice in which it appears you don't have or
and ALK less than 300 in acute hepatocellular disease (viral, toxic,
chronic liver disease and infiltrative disease).

The transaminases are used more in diagnosis than as an indicator of
disease severity. The bilirubin and albumin are used more for that.

Apart from the conditions that Jeff mentioned is one important one that
would point to a false increase and that would be immunoglobulin
complexed ALT that is not cleared by the kidneys and so it is raised in
the blood. This is not a disease but a laboratory abnormality only.
Special techniques are needed to prove that but if the only abnormality
is an ALT then that would be highly suspicious. Pretty rare and I have
not seen one of those.

A liver biopsy might be undertaken if nothing shows up by non-invasive
testing.

.