AST/ALT high, other LFT are very normal

[scaredman2010]

Dear Doctor,

Would appreciate if you can comment on my latest LFT result. Does it indicate liver damage or something else? Has been posting in multiple forums. Want to get a second opinion.

Protein, Total : 73
Albumin: 46
Globulin: 27
Bilirubin, Total : 3 (it is indicated low, as I normally get 7-10)
Alkaline Phosphatase, Total: 67
Alanine Aminotransferase : 114 (high)
Aspartate Aminotransferase : 207 (high)
Gamma-glutamyltransferase : 28

I am Hep B carrier under lamivudine treatment. Last HBVDNA test was last year Aug and negative. HBeAg changed from positive to negative after 3 years of lamivudine treatment and has kept as negative so far. However, my doctor want me to continue take lamivudine after sero-conversion. Moreover, happened to test ALT (part of yearly body check) 4 days ago before above test, and the value is 42. So far, I am feeling great, eating and sleeping normal (apart from anxiety). Moreover, I have LFTs test every 4 months and all normal so far.

I am not drinking or taking any medicine, except herbs. (Taken some Valerian root before testing) I have searched Internet lately, and found that AST elevated faster than ALT, may due to muscle sore. I had weight training 2 days before the test, and some muscles are pretty sored during the blood taking.

[zeak12884]

The dr. Is referring to bilirubin as reported here in the USA, in mg measurements.  I believe yours is probably  in mmol measurements.  Which is used In many other countries from my understanding.  There are conversion charts online.  Hope this helps.

[scaredman2010]

Moreover, it never been reported as with a decimal? It is always been an integer. Thanks!

[scaredman2010]

Dear doctor,

Thanks for following up.

Is there another scale of Bilirubin. I have been monitored for Hep B status for the past 8 years. My Bilirubin is ranging from 7-10, and it is always indicated as normal in my report. This time, I got 3, and it was indicated as LOWER in my lab report. I am very confused and worried that if my Bilirubin has been 50+ times than normal and my doctors did not tell me!!!!???

[Poorna Chandra, SMD, DM]

Dear scaredman2010,

Thanks for writing back.

Normal value of total Bilirubin is 0.1 to 1.2 mg/dL. Your total Bilirubin level is 3 which is high.

Hope I have cleared your doubt. Wishing you good health.

Best Regards,
Dr. Poorna Chandra

[scaredman2010]

Hi doctor, I think my Bilirubin is lower than normal but not elevated.

[Poorna Chandra, SMD, DM]

Dear scaredman2010,

Thanks for the query

There are certain points of uncertainty in your query. HBV carrier state is not normally treated and one initiates therapy only if there are elevated SGOT & SGPT along with a raised HBV DNA levels. Bilirubin is always normal in a carrier where as it is elevated in your case.  

Muscle related rise in SGOT is usually not associated with significant raise in SGPT and any elevation in bilirubin.

Lamivudine if used for more than 6months has a high likelihood of leading to the development of resistant virus and subsequently a flare of hepatitis. Hence in your case one cannot rule out a viral breakthrough and a hepatitis flare.

HBV hepatitis is of two types: HBeAg +ve HBV hepatitis and HBeAg -ve HBV hepatitis. Hence it is better to test for HBV DNA rather than looking at HBeAg.

Hence I would suggest you to consult your gastroenterologist and get these issues clarified.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Poorna Chandra