Dear Mailbase participants,
I'd be very grateful for the help of this forum. We are currently
'discussing' (read what you like into the quotation marks!) the usefulness
of requesting alpha-1-antitrypsin and caeruloplasmin in patients with
asymptomatic abnormalities of liver enzymes . Othe tests in the 'screen'
include ferritin, hepatitis serology, AFP, AutoAb, liver USS, often tumour
markers, Igs, protein EPS.
We have agreed that caeruloplasmin is unlikely to be useful in those over
50 (perhaps we should drop this to 40 given the NEJM paper by Pratt and
Kaplan 2000; 342: 1266-1271). We run into difficulties over the following:
how abnormal is abnormal?
should these investigations be done if only the YGT is raised?
AAT concentration vs. phenotype - we currently only offer concentration and
could not sustain the numbers if all went for phenotying (372 last year -
all normal) - most have an electrophoretic strip done as well
? usefulness if known other diagnosis to explain abnormal enzymes - hep B,
C, ETOH.
I'd be interested to know how others approach this and if there are any
published guidelines. I will happily collate the responses for the mailbase
and send apologies if this has been discussed before.
Anne Tarn
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