New "normal" ranges for ALT??

Hey peeps gotta quick question: I just picked up copies of some bloodwork I had done (cholesterol, routine chemistry, general hematology etc) and was a little confused by something on the liver panel. My AST is 17, which I was pleased with. My ALT is 29, which I'm not upset with, but always thought a value of 29 was slightly elevated (although still within normal range). I drink beer and wine (and am 2 year SVR), so I wasn't terribly surprised nor worried it was 29.  But my ALT = 29 was flagged as being "Low", which did surprise me. It says the normal range for ALT is 30-65 U/L. I checked my old lab reports and sure enough they state normal ranges for ALT as 0-55 IU/L (LabCorp) and 6-43 U/L (Covance). I did a quick google search and found a few websites that stated new limits have been set based on gender (with men having a normal value of 30 and women 19). Still, isn't it a bit confusing to flag ALT as "Low" when it's 29? Seems to me the normal range should essentially go down to zero, unless perhaps there's severe cirrhosis?

Anyway, I've been outta the loop for awhile, so I'm not up on this new change. Anyone have the lowdown on these new "normal" ALT ranges? Thanks in advance...

[newleaf09]

Were the new labs done by the same testing company?  I've not heard of new limits but every testing company sets their own within data taken on their populations for 'normal'.

[mikesimon]

That is news to me. I have trouble believing that 30 will be the new low normal for ALT in men. The reference range on my Quest Diagnostics report is 9 - 60 U/L and I have thought that 60 might be too high for the reference range. I am almost sure I have read that at least one expert is recommending lowering the reference ranger for ALT in people suspected of having liver disease and that ALT of 30 should trigger further testing. I can't find it now but I am almost sure I have it somewhere.
Mike

[copyman]

I remember a doctor saying the lower the better for ALT. I thought I had read that they were lowering the # for normal. A good functioning liver should have ALT & AST in the teens. I would think that lower the number the better chance that no inflamation (inflammation) is going on.

[mremeet]

Yep, that was my understanding concerning ALT as well. I'm wondering if the test itself has been changed or adjusted to report a higher numerical range, possibly to increase the sensitivity and/or resolution of the test. That seems unlikely though, at least not without some kind of supplemental notation on the lab results. Another thing is that the units used on this recent result is "U/L" or units per liter. Other tests I've had have it listed as "IU/L", presumably international units per liter(?) I wonder if there is any difference between "U/L" and "IU/L"? Perhaps similar to viral load, where you have to divide copies/ml by 2.5 to get IU/ml? Dunno...

Hopefully someone knowledgeable can chime in so I can get it settled. This is certainly the first time I've been flagged for "Low" ALT ;-)  Also, their acceptable upper limit of 65 was a typical value I'd have while actively infected with HCV.  Seems like we have another BS communication error/Lab result fiasco going on here.

[gauf]

NORMAL RANGE 7-56 U/L from Janis site.

My labs show it it at NORMAL RANGE 5-50 U/L.

Seems different labs have different ranges!

[Marc1955]

Different labs do have different ranges, but I've never understood the reason why, since they seem to be measuring a standard unit not something of their own devising.

I've done a similar literature search to yours which indicated that according to some studies, the upper range for normal for men is around 30 and the upper range for women is in the teens. But I've never heard any suggestion that this research was sizable enough to lead to changes in the standard lab measurements which usually go to twice that point. These were researchers who were testing to see whether a reduced range for normal liver enzymes would have diagnostic benefits.

So I'm as clueless as you are. I can't imagine a reading of 29 being interpreted as low. I'd be curious to know the answer if you get one.

[copyman]

I think this is a question that HR could give expert opinion on.  

[mikesimon]

I don't think there is a distinction between U/L and  IU/L.
Different labs do have different reference ranges but my experience has been that there isn't much difference among them. A low normal range of 30 is way out of line with the lab sheets I have seen and I have seen several.
Regardless, your 29 is within all the reference ranges I have seen so at least you're not high which is what I worry about.
Good luck getting this straightened out.
Mike

[jmjm530]

Good to see your name. As to your concern, maybe you should up your alcohol intake to bring that ALT within "normal" range. LOL.  But seriously, your numbers sound good to me, not to worry.

-- Jim

[GoofyDad]

At my old liver clinic (a TP center) they got new machines and all their patients went up by a good whack. I don't remember exactly how much, but maybe 7 pts or so. Apparently it can be lab/hardware dependent.  

[mremeet]

jim - Good seeing your name too, thanks. How those washboard abs coming along? Still doing the low carb thing? And yeah I'm not worried, just wondering if it's some stupid error in the lab report format. My gut tells me their reported reference range of 30-65 (and my 29 as being "Low") is a communication screwup based on our experiences with the horrible lack of clarity and confusion seen on viral load test reports (amongst other tests). And based on my knowledge and experience monitoring ALT's over the years, it does seem like a good idea to lower the upper limit of what has traditionally been called "normal." It shouldn't be 43 or 55, the upper normal limit probably should be about 30. That way a non-GI/GP would know something might be up and further testing is warranted. Unfortunately it doesn't provide a phone number on the report for the lab director. I'll probably try and track him down and ask what the deal is. It is interesting to read there are differences between the sexes when it comes to ALT though. I don't recall reading that before. I'm also a little surprised my AST is in the teens and isn't at least in the low 20's as well...almost makes me wonder if the ALT value is being amplified due to some kind of new testing technology? Hard to say....

GD- hey goof, wassup? That's interesting to hear they have a new machine that spits out bigger numbers. I dunno, maybe that's what this is about? I'll try and contact the lab dude and see what he says. I would talk to my GP about it, but I know all he will do is say "Oh it's ok, see here where it's below normal level? That's nothing to worry about. That'll be a $20 copay please."

Yeah. ;-)

[zazza]

A man with a BMI of less than 25 should have an ALT of 30 or lower. A woman with a BMI of less than 25 should have an ALT of 19.2 or lower. That said I have seen people SVR who have had higher ALT than that and still been skinny.

[desrt]

Have a birthday recently? I recall the normal range on my ALT/AST shifted when I turned 50. Numbers stayed the same, but I suddenly became 'normal' by aging a year.

[apache1]

On my Quest report from 4/28/09
ALT normal range is  9-60 u/l
My NP also said anything UNDER 30 being the bottom of normal seems like a error somewhere.


desrt:
"I recall the normal range on my ALT/AST shifted when I turned 50."
=================================================

Yup, the eGFR range just changed on my Quest reports last test.
normal went from .66-1.30 to .75-1.46, wonder if its age related also ?



-------------------------------------------------------------------------------------
jim:
""maybe you should up your alcohol intake to bring that ALT within "normal" range"
==================================================
;)
My ALT16 is way low, how many Corona will I need to get normal ...

apache

[apache1]

correction:
should read
My NP also said anything UNDER 30 is good.
IMO, over 30 being the bottom of normal seems like a error

[willing]

(these d*ed SVRs complaining about their ALTs being too low... - )

glad to hear everything is going well!

I had actually been wondering the same since the range of my recent tests doesn't match those of  earlier tests. (though mine are going in the other direction)

This is a clinical practice guideline that seems to confirm the above comments:

http://www.ncbi.nlm.nih.gov/pubmed/11106349

- different labs/assays have different ranges; unlike say glucose, there is no global scale
- values are both age and sex dependent (see chart in Fig 1)
- changes in the 10s are likely noise

if you actually manage to find the director for your lab it would be interesting to hear how they standardized their reference range.

[GoofyDad]

"It is interesting to read there are differences between the sexes when it comes to ALT though. "

Let me tell ya son, that's just the tip of the iceberg......

[mremeet]

Hey everybody, I'm back again for another round of beating a dead horse. I was a vertex Prove 1 study participant (Telaprevir), started treatment in Aug 2006, stopped in June 2007, received Telaprevir+SOC.  I just got my 4 year post Tx (SVR) labs back. I'm still negative on my HCV PCR, so I would be in the longest running Telaprevir SVR club (so far). Back in the day, a few people were concerned the telaprevir SVR's might not be as durable as a "standard" IFN+riba SVR. So far so good, my Telaprevir SVR seems as durable as anyone elses.

Also, once again my liver enzyme levels are a bit strange from what I expected back when I was being treated. My AST is 8 (which I'm quite happy with), with is flagged as being "Low" (normal ref range 15-37 U/L). My ALT is 28, again being flagged as "Low" (normal ref range 30-65 U/L). As stated previously in this old thread, I was wondering if any new information was available about what constitutes the so called normal reference range for ALT?  My recollection is that having an ALT in the teens is what you wanted and it wasn't possible to be flagged as "low." The lower the value you had, the less liver cell death you had. So hopefully some of the regulars know the latest-greatest on interpreting lab results and any possible differences between ALT tests today vs 5+ years ago.

Also, anyone know what the normal range for Basophils are?  They can be reported in absolute terms or percentage. My result is reported in percentage. It's reported as 1.6% and is flagged as being high. It claims a normal ref range of 0.0-0.2%, which would make my result about 10X higher than it should be. But all googling I do for basophils says 0.0-2.0% is the normal range. And when I add up all the white blood cell types on my labwork (reported in percentages) it comes out to exactly 100% - which it should, as I recall. Anyone have any insight into this? If my basophils really are 10X higher than they should be, I suspect this is something I should look into, so any help would be appreciated.

[willbb]

Labs seem to report slightly different Normal ranges. The normal range on my lab report for ALT reads <35  so yours  at 28 would seem normal .My Ast refereance range  reads  5 - 31..so again ..looks like you are doing great ..at least according to my lab .

The  basophiles and also the eosinphils are usually raised if there is some time of allergic reaction going on.....however I know mine jump around a bit from one blood draw to the next and yours are  only very slightlyraised at 1.6 %  I believe optimum is about 1% . I would imagine your doc said there is nothing at all to worry about.

Oh...and a hearty congrats on the sustained SVR...
Best
Will .

[willbb]

BASOPHILS and BASOPHIL COUNT


Basophilic activity is not fully understood but it is known to carry
histamine, heparin and serotonin. High levels are found in allergic
reactions, low levels are normal.


Normal Adult Range: 0 - 2 %
Optimal Adult Reading: 1

http://groups.google.com/group/sci.med.diseases.hepatitis/msg/247015d11c4117c2?&q=blood+definitions

[curiouslady1]

Since you are in another country, I thought I would add my lab range to the mix.  This is a lab used by the University for its research.  The ALT reference range is 0-47 and AST is 0-37.   I don't believe the reference range is gender specific.