Elevated liver proteins: how bad is this?

Factual Questions
1

Usual disclaimers apply–my wife has a doctor’s appointment on Monday to go over these lab results, we are not seeking medical advice, etc. But my wife is freaking out a bit, and we would like some information.

My wife has Hepatitis C, apparently acquired via a blood transfusion back in the 80s before there was a specific test for Hep C in the blood supply. So far, her liver function has been good, and her viral load pretty low. But she just had a battery of tests done, and some levels are high. The levels are:
ALP (normal 34-104): 123
ALT (normal 5-31): 49
AST (normal 12-28): 41

(My apologies to US doctor dopers; these values are in μmol/l, not mg/dL.) Anyhow, Wiki tells me that all of these are related in some way to liver function, and elevated numbers can mean liver damage. What do these numbers mean? I mean, does this strongly indicate liver damage? How bad are these numbers? Thanks in advance for any help.

BTW, if it matters, her total protein is also high: 93, with a normal range of 64-79.

2

As the hepatitis ruins the liver cells, they break open/collapse and the stuff inside gets out. That accounts for the higher levels. The bloodwork measures this as an indication of ongoing liver damage.

The only way to diagnose the liver directly is a biopsy. Be very careful when getting a liver biopsy. I had a really bad experience with that once.

3

[QUOTE=Johanna]
As the hepatitis ruins the liver cells, they break open/collapse and the stuff inside gets out. That accounts for the higher levels. The bloodwork measures this as an indication of ongoing liver damage.

The only way to diagnose the liver directly is a biopsy. Be very careful when getting a liver biopsy. I had a really bad experience with that once.
[/QUOTE]

She had a biopsy, but it’s been years (4, I think). It was normal then, but that was probably too long ago to tell us anything useful now.

4

[QUOTE=Sophistry and Illusion]
Usual disclaimers apply–my wife has a doctor’s appointment on Monday to go over these lab results, we are not seeking medical advice, etc. But my wife is freaking out a bit, and we would like some information.

My wife has Hepatitis C, apparently acquired via a blood transfusion back in the 80s before there was a specific test for Hep C in the blood supply. So far, her liver function has been good, and her viral load pretty low. But she just had a battery of tests done, and some levels are high. The levels are:
ALP (normal 34-104): 123
ALT (normal 5-31): 49
AST (normal 12-28): 41

(My apologies to US doctor dopers; these values are in μmol/l, not mg/dL.) Anyhow, Wiki tells me that all of these are related in some way to liver function, and elevated numbers can mean liver damage. What do these numbers mean? I mean, does this strongly indicate liver damage? How bad are these numbers? Thanks in advance for any help.

BTW, if it matters, her total protein is also high: 93, with a normal range of 64-79.
[/QUOTE]
These numbers indicate mild liver inflammation (at present). The high protein likely represents hypergammaglobulinemia, a common finding in liver disease which, by itself, adds little or nothing to the diagnosis.

5

[QUOTE=Sophistry and Illusion]
Usual disclaimers apply–my wife has a doctor’s appointment on Monday to go over these lab results, we are not seeking medical advice, etc. But my wife is freaking out a bit, and we would like some information.

My wife has Hepatitis C, apparently acquired via a blood transfusion back in the 80s before there was a specific test for Hep C in the blood supply. So far, her liver function has been good, and her viral load pretty low. But she just had a battery of tests done, and some levels are high. The levels are:
ALP (normal 34-104): 123
ALT (normal 5-31): 49
AST (normal 12-28): 41

(My apologies to US doctor dopers; these values are in μmol/l, not mg/dL.) Anyhow, Wiki tells me that all of these are related in some way to liver function, and elevated numbers can mean liver damage. What do these numbers mean? I mean, does this strongly indicate liver damage? How bad are these numbers? Thanks in advance for any help.

BTW, if it matters, her total protein is also high: 93, with a normal range of 64-79.
[/QUOTE]

What does she usually run?

These are trivial elevations. It’s unlikely the recommendation will be anything but to recheck them at a later date, and to make sure no external liver irritants such alcohol, are present.

With chronic hepatitis from any cause, elevated transaminases (the ALT and AST) and alkaline phosphatase (the ALP) are not an accurate way to follow the disease. They do not correlate well with liver function at all, even though we have a careless tendency to refer to them as “liver function tests.” Neither do they correlate with the underlying degree of damage. The numbers you gave are very low elevations of fairly sensitive enzymes.

While it is true that a biopsy might provide additional information for chronic liver disease, these numbers in isolation, particularly in a patient with known Hep C, do not create an indication for a biopsy.

6

[QUOTE=Chief Pedant]
What does she usually run?
[/QUOTE]

Unfortunately, I don’t know; we haven’t gotten her tested as often as we probably should.

7

Pretty much what pedant said.

In these parts, we consider surveillance biopsies every 5 years or so, which helps to establish whether a person is a slow progresser or not.

If one is a slow progresser, chances are pretty good that one will die of old age before dying of liver disease (as long as one avoids alcohol).

And if she acquired the disease back in the 80’s and had a normal liver biopsy 4 years ago, that may be enough in itself to establish her as a slow progresser. Once that’s been established, the need for further biopsies is usually much diminished.

But she should follow her doc’s advice on the issue of how to proceed.

8

This is a huge relief. Thanks, everyone, for your input.

9

Best of luck to her. My friend is about to start treatment.

10

[QUOTE=Shoshana]
Best of luck to her. My friend is about to start treatment.
[/QUOTE]

Thanks, and best of luck to your friend. We’re hoping **QtM ** is right and my wife won’t need treatment; in general, her health is not too great and I think she would tolerate the treatment poorly, since it apparently has many serious side effects.

11

Sophistry and Illusion, while alcohol is the most famous liver irritant, my mother gets elevated transaminases quite frequently and she doesn’t drink enough to justify them nor does she have liver insuficiency or hepatitis; she has bad health and geegollywhiz, all those medications also affect the liver. One of the things I’ve had to teach her is to read the prospectus for any medication carefully and if it includes something like “may cause liver problems”, ask her doctor to look for other options.

12

[QUOTE=Nava]
Sophistry and Illusion, while alcohol is the most famous liver irritant, my mother gets elevated transaminases quite frequently and she doesn’t drink enough to justify them nor does she have liver insuficiency or hepatitis; she has bad health and geegollywhiz, all those medications also affect the liver. One of the things I’ve had to teach her is to read the prospectus for any medication carefully and if it includes something like “may cause liver problems”, ask her doctor to look for other options.
[/QUOTE]

This is good to know; one reason the doctor ordered these blood tests now is that she wants to put my wife on Zoloft, and wanted to check her liver function before doing so (I guess since Zoloft is also hard on the liver). I’ll make sure she asks the doctor pointed questions on Monday.

13

**Sophistry and Illusion, **do you feel like giving an update on your wife’s health?

14

[QUOTE=Shoshana]
**Sophistry and Illusion, **do you feel like giving an update on your wife’s health?
[/QUOTE]

Well, she’s supposed to go in this week for a liver ultrasound, so we won’t know more until that happens. I don’t know whether this procedure takes the place of a biopsy, or just tells whether a biopsy is necessary.

15

How are you and your wife holding up?

Our experience was that the ultrasound doesn’t substitute for the biopsy, and that the biopsy, while nervewracking, was pretty straightforward and not painful. The worst part was the determination that my friend needed treatment and then waiting while that was lined up.

I just posted a link for a hopeful article over here.

Send me a private message if I can be helpful.

16

[QUOTE=Shoshana]
How are you and your wife holding up?

Our experience was that the ultrasound doesn’t substitute for the biopsy, and that the biopsy, while nervewracking, was pretty straightforward and not painful. The worst part was the determination that my friend needed treatment and then waiting while that was lined up.

I just posted a link for a hopeful article over here.

Send me a private message if I can be helpful.
[/QUOTE]

We’re doing okay. Her liver seems pretty healthy. We are leaving Hong Kong later this week to move to the States, so we will connect with a doctor over there to follow up. But she’s had the Hep C for so long (18 years) and it hasn’t done any significant liver damage, so we’re hoping that we will be able to forego treatment altogether, as long as she avoids liver irritants like Tylenol and alcohol.

Best of luck to your friend; I hope the treatment does the trick.