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Gastroenterology (Expert Forum)
Anomalous transient spike in liver enzymes (ALT)
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Anomalous transient spike in liver enzymes (ALT)
by rterbeek, Nov 11, 2005 12:00AM
I am a 57 year old male in supposedly excellent health. My lifestyle is squeaky clean and I'm at virtually zero risk for hepatitis. During a routine check of my donated plasma my ALT came back as 262 U/L. I immediately went in to the local VA clinic and had a liver panel done, and everything came back normal, except that the ALT was still elevated at 78 U/L. This was after approximately 191 hours after the donation of plasma with the 262 U/L, and about one hour after I discovered the results.
The only thing I can think of that might have caused this spike is that I had a flu shot the day before and I forgot to tell the plasma clinic about it until several days later.
Scouring the internet, I have been unable to find any references to the effect of flu vaccine on hepatocytes. If that (the flu shot) is the reason for elevated ALT, can you tell me the mechanisim by which the hepatocytes are affected. (I have a background in life sciences, so you can be as technical as you wish - I will understand).
Also, given the serum half-life of ALT of 37-57 hours (the best numbers I could find), it seems as if the the serum ALT would have returned to normal after 191 hours, yet it was still 78 U/L. This is much higher than my normal levels of 24-34 U/L.
Could it be that the level was still increasing to a higher level (higher than 262 U/L) for a day or two before starting to decline?
Granted, all this is based on the assumption that the flu shot may have caused this spike in ALT. Other factors to consider are medications (I've been taking 1000 mg naproxyn for years, and an aspirin a day for about a year with no noticable effect. Other medications are wellbutrin (300mg / day to control depression), quetiapine (50 mg at bedtime for sleep), and multivitamins and essential oils as dietary suppliments.
Your thoughts on this, please.
RTB
The only thing I can think of that might have caused this spike is that I had a flu shot the day before and I forgot to tell the plasma clinic about it until several days later.
Scouring the internet, I have been unable to find any references to the effect of flu vaccine on hepatocytes. If that (the flu shot) is the reason for elevated ALT, can you tell me the mechanisim by which the hepatocytes are affected. (I have a background in life sciences, so you can be as technical as you wish - I will understand).
Also, given the serum half-life of ALT of 37-57 hours (the best numbers I could find), it seems as if the the serum ALT would have returned to normal after 191 hours, yet it was still 78 U/L. This is much higher than my normal levels of 24-34 U/L.
Could it be that the level was still increasing to a higher level (higher than 262 U/L) for a day or two before starting to decline?
Granted, all this is based on the assumption that the flu shot may have caused this spike in ALT. Other factors to consider are medications (I've been taking 1000 mg naproxyn for years, and an aspirin a day for about a year with no noticable effect. Other medications are wellbutrin (300mg / day to control depression), quetiapine (50 mg at bedtime for sleep), and multivitamins and essential oils as dietary suppliments.
Your thoughts on this, please.
RTB
Doctor's Answer
by Kevin Pho, MD, Nov 12, 2005 12:00AM
, Nov 12, 2005 12:00AM
I am not aware of he flu vaccine leading to an elevation of the ALT.
The medications you are taking, including the NSAID, wellbutrin and quetiapine can transiently raise the liver function tests. Alcohol and over the counter medications like Tylenol can also do the same thing.
To further evaluate the elevation, you can consider a liver ultrasound to evaluate the liver and gallbladder anatomy, as well as blood tests to definitively rule out hepatitis.
If negative, serial monitoring the liver enzymes is recommended.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
The medications you are taking, including the NSAID, wellbutrin and quetiapine can transiently raise the liver function tests. Alcohol and over the counter medications like Tylenol can also do the same thing.
To further evaluate the elevation, you can consider a liver ultrasound to evaluate the liver and gallbladder anatomy, as well as blood tests to definitively rule out hepatitis.
If negative, serial monitoring the liver enzymes is recommended.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
Sorry about my poor command of english language & vocabulary as its not my mother tongue.