Confusing Labs and Tests?

[JTB2601]

I'm a physically fit, active male in my 50s.  During a routine physical we discovered an elevated reading on my LFT (ALT of 106, AST Normal).  My medical history includes major surgery with multiple blood transfusions in the mid-80s.  Being high risk for HCV, we repeated the tests plus other with these results:
ALT             91
AST             39
Transferrin    186
TIBC            228
HCV Antibodies  Positive
(All other results were normal)

I was referred to a specialist, and follow on tests confirmed positive HCV antibody test, but was unable to establish genotype due to insufficient viral load (HCV RNA QN less than 50).  My blood ammonia level was 74. (I'm now on lactulose, but don't notice any difference - I have no symptoms)

I have since had lab tests for what I believe is to rule out genetic or autoimmune issues, plus a CAT scan.  The doctor has the results, but I have not seen him yet and don't know what he found out (and the lab won't give me the results directly).  But he just order a new hepatic lab plus a CBC, which makes me think he's unsure what's going on.

I don't see him for another two weeks.

Without putting you on the spot, what do you think are possible dignosis, and what additional tests might I anticipate the doctor wanting to do?

[nygirl7]

Congrats - that is just fantastic news!

[JTB2601]

Got my results yesterday.  All labs were normal this time except ALT, which was 71.  And CT scan of liver concluded it was essentially normal (although CT detected kidney cyst).  I'll do a blood draw today to check ammonia.  But doc has concluded I'm one of the luck 10-20% who managed to clear HCV without treatment.  Follow-up labs in 3 months.......just to be sure.

Thanks to all who provided valuable insight and words of encouragement.  Best of luck to you.

[JTB2601]

Thanks Jim.  Good article.  I had found much of this info in various places, but this was the best, most concise article I've seen.

My doc is a gastro, but with major experience and an excellent reputation for hepatitis treatment.  But to date I've seen him for 20 minutes and the nurse practitioner for a half hour....tops.  I'm not overweight (well, a little heavier than I used to be....), retired military, I've run marathons and still hit the gym almost daily (although I've stopped while we sort this out).  Even the doc commented on my physical condition.  I do drink alcohol, beer occasionally and wine almost every evening, but not since the first abnormal lab test came back.

I'll just wait til I see the doc and keep my fingers crossed.  Although I wish I had the results of the CAT scan and last 2 rounds of blood "donations" I'm at least reassured that my doctor is being very thorough.

Best of luck to all of you on this forum.  I can appreciate what a scary thing you're going through.

JB

[nygirl7]

Good luck, as the others have said you just might be one of the lucky 20% who have already beaten this disease off with your own immune system.  Here those of us who did not take treatment so that we can train our immune systems to do this - but hopefully yours already has.

Having a high ALT and AST usually means something is wrong with your liver though so I would advise to keep on going to the doctor until you can find the cause of why the ammonia level is so high and what you can do to stop the cell damage from being done to your liver.

[jmjm530]

This article may be helpful.

http://www.aafp.org/afp/20050315/1105.html

Note the emphasis on getting a thorough history which I assume your medical team did. So many causes for mildly elevated ALT from rx drug use to alcohol to even strenuous exercise. Are you overweight? I'm sure they are going to check fatty liver as well.

Anyway, you can probably see why so many tests are being done and why a live specialist might be needed to help evaluate the results. Hopefully, it won't be anything serious.

-- Jim

[jmjm530]

Your doc appears to be proceeding correctly and I assume he will repeat the viral load test again, perhaps using a more sensitive test this time. Something perhaps down to 5 IU/ml, as opposed to 50. I doubt this would make any difference, but no harm in covering all bases especially with an elevated ALT.

As you've been told, if your viral load tests are negative (and remain negative) then you do not have Hepatitis C. Your antibody test may have been a false positive or you may have had the virus in the past and fought it off. In either case, you don't have it.

Is your doctor a liver specialist (hepatologist) or a gastro? Since things remain inconclusive, if you aren't already, I'd suggest you see hepatologist as r a second consult. They are the experts in liver-related matters and their clinical experience can result in a better diagnosis and put things in better perspective. Anyway, that is who I would see if in your position although it does sound like your doc is proceeding correctly.

-- Jim

[JTB2601]

The doctor (actually the nurse practitioner) considered the blood ammonia level to be high, but I certainly didn't feel i was experiencing any symptoms.  Hopefully on my next visit in a coupe of weeks I can get off the lactulose. I travel a lot with me job and the treatment isn't much fun.

The suspense is killing me.  Especially having the doc order a new hep screen plus CBC following the CAT scan.  Makes me wonder if he suspects something else may be going on.  Guess I'll just have to wait, unless somebody else out there has experienced similar situation.

And thanks all for the quick response.

[Bobby1952]

   Your'e right the labs are confusing. That is why your specialist is ordering more tests.
The  "HCV Antibodies  Positive" means you were exposed at one time but the less than 50 on the Viral Load usually means that you don't have HCV. HCV doesn't usually exist at low extremes unless you are on treatment. But it could always be a false indication.
   That is why your DR is ordering more tests. A second round of tests should confirm or unconfirm this. I know it is difficult but you will just have to wait it out.
  
   Come back and let us know what the results are. I have a question about the ammonia level. Is 74 high. I didn't think so. If not then why are you being given Lactulose?  The only thing that bothers me is the elevated ALT of 91 which is considered mildly elevated.  

Bobby

[PegOnPeg]

Sorry didn't mean to post so quickly...

The normal range of ALT levels is between 5 IU/L to 60 IU/L

Elevated, for sure..intersting that the VL is @ a level where he can't determine genotype...I'm wondering if you're one of those that fought it off...

there are plenty more experinced ppl that will have a better idea of what's going on...just hang around for a while..

good luck **

[PegOnPeg]

ALT is a more specific indicator of liver inflammation than the AST, as the AST may also be elevated in diseases affecting other organs, such as the heart or muscles. The AST is also elevated after a myocardial infarction, and during acute pancreatitis, acute hemolytic anemia, severe burns, acute renal disease, musculoskeletal diseases, and trauma.

The normal range for AST levels in the bloodstream are 5 IU/L to 43 IU/L.