liver damage from cold agglutinins

My father has cold agglutinin disease and has an elevated bilirubin of 3.8 and an alkaline phosphatase of 147. Other blood values seem normal...He swears he feels fine... His doctor is retesting the liver function... What are the risks of this level of bilirubin? Should he have a liver biopsy?
Thanks
Eileen

[imkindly]

What he has is an autoimmune disease (a type of hemolytic anemia). The body attacking it's own red blood cells.
Destruction of red blood cells would cause his bilirubin level to rise.

Cold agglutinin disease is an acquired autoimmune hemolytic anemia due to an autoimmune antibody (usually) directed against an antigen on the surface of red blood cells. These autoantibodies (of the IgM variety) usually will not react with cells at 98.6_ but only at lower temperatures.

In the cooler parts of the body (fingers, nose, ears), the antibodies will cause the red blood cells to stick together briefly. Cell damage results indirectly from attachment of the protein to the cell wall by complex reactions.


Here's some pages where you can read more about what your father is dealing with:

http://www.hopkinscancercenter.org/types/hemolyticanemia.cfm

http://www.emedicine.com/med/topic408.htm

http://www.aarda.org/page14.html

http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Anemia%2C%20Hemolytic%2C%20Cold%20Antibody

Keep him warm.
Does he take Folic acid?

[ebsully]

He takes a multi-vitamin, Why folic acid?
Eileen

[imkindly]

If you go to that emedicine page at  http://www.emedicine.com/med/topic408.htm , they mention folic acid alot. It's a huge page, but if you go there, scroll down to

Section 6 - Treatment:

Diet: Patients should include good sources of folic acid, such as fresh fruits and vegetables, in their diet.

Section 7 - Medications:

Folic acid supplementation is advisable to meet increased requirements of increased RBC production due to hemolytic anemia.

(and more details under Drug Category: Hematinic)  

Section 8 - Follow Up:

In/Out Patient Meds:  Folic acid 1 mg

Patient Education:
Educating patients about the importance of keeping all body parts warm at all times and avoidance of cooling of body parts is essential in a chronic disorder. Appropriate clothing is necessary in cold environments.
Patients must comprehend the importance of daily intake of folic acid to supply a needed hematinic. Folic acid could easily become a rate limiting hematinic in a patient with a chronic hemolytic process.
Long-term follow-up care and vigilance for the development of systemic symptoms of any lymphoproliferative disorder are necessary because patients may become dejected about a chronic process.
Avoidance of cold foods and working in cold storages is also important.


Most multi vitamins have folic acid in them-----but it's usually in mcg. (micrograms)
To get a dose as large as 1 mg. you need a prescription.

1 mg. = 1000 mcg.