High ALP in non-drinker

[fdp]

Hello,
In July, one year after my last physical yielding normal blood work, my alk phos came back at almost 300. The test
was repeated a week later with the similar result.  (I do NOT drink at all.)
In April I was put on antibiotics as well as taking some Tylenol.  Could these medications, three months later,
be the cause of such a high ALP?  Would my ALP remain so very high and for how long until it normalizes again?
Thank you.

[Thomas D Schiano, MD]

that should have no affect on causing the persistently abnormal liver tests

[Thomas D Schiano, MD]

if there is any concern for an overlap syndrome with autoimmune hepatitis then a liver biopsy will be essential. if there is autoimmune hepatitis you would need azathioprine, for PBC predominance actigall alone. It seems like we need to wsait for the biopsy result.

[fdp]

I just heard from the hepatologist again, after more blood tests.
She's afraid that besides for PBC I have another autoimmune
process going on and will retest me next month and probably
do a biopsy following.

If I do have both situations, what is the course of treatment and
how successful can it be?  I'm very concerned.
Thank you.

[Thomas D Schiano, MD]

tylenol would not cause the AP to be elevated on a chronic basis

[fdp]

I just spoke with a friend and I do understand this is not Tylenol-related.
Thanks.

[fdp]

Hello Dr. Schiano,
Blood work was repeated and, as you said, it appears to
be PBC.  Alk phos is now 350 (was 300) and IgM is elevated.
I'll be started on medication with repeat blood work early 2013,
biopsy pending on the results of that blood work.

I still keep thinking it is from Tylenol use, but I am told that the
pattern is not representative of that and is of PBC.  What is the
difference between the two?
Thank you.

[fdp]

Yes, sorry for the redundancy, and I really appreciate your help.

I was told that continuing to take acetaminophen and ibuprofen in
normal amounts is OK however I am uncomfortable doing so -
may I ask your recommendation?  Thanks again and have a nice
weekend.

[Thomas D Schiano, MD]

OK--this is the right approach

[fdp]

Thank you.
I do know that in the next round of blood work, another
"Ig_" (I don't remember which one) will be done as it
was the only one that my internist did not run before I
saw the hepatologist.  

The hepatologist was also leaning to the PBC dx,
however the oddity was that my alp was
normal one year earlier and she said that normally it
creeps up over time, doesn't go from normal to almost
300.

I will have more blood work in the next four weeks and
then either I'll have a biopsy and/or the course of treatment
will be started.

[Thomas D Schiano, MD]

the titer is very low so I am sold that you have PBC.  People who have AMA (-) PBC generally have an elevation in their IgM level.

[fdp]

It's marginal, 1:20.
I would be happy to forward my entire labs if you'd like (ultra sound was normal).

All my medical care is at a major teaching university in a major city.
Thanks.

[Thomas D Schiano, MD]

i agree with the plan.  How strong is the AMA titer?

[fdp]

Yes, Dr. Schiano,
the AMA is positve.

When the blood work is repeated in several weeks,
she will do another specific antibody test that was
not done previously.  Depending on the result, a
biopsy may follow.

Thank you again.

[Thomas D Schiano, MD]

keep me in the loop.  is the AMA blod test (+)?

[fdp]

Thank you.
I saw the hepatologist and she believes that it is
PBC. More testing will be done.
I was hoping for a less ominous diagnosis.
Thank you again.

[fdp]

Hello again Dr.,
I just realized that I had been taking Tylenol within three weeks
of my blood work, however I did NOT exceed 3000 mg/day.
I did use it daily over an extended time period as I had a knee injury.
Thank you.