Dear Anne (and all)
I once asked this question of our gastroenterologists as I was interested in
their views. One said that she would not add further tests, believing that
almost all minor abnormalities of LFTs were due to "fatty liver". The
second gave me a very full list of second-line tests, including
alpha1-antitrypsin and caeruloplasmin together with all antibody tests for
hepatitis etc. I felt that perhaps we should give up on the question.
But I am personally convinced of the need for doing alpha1-antitrypsin as
there is direct advice to be given to patients with this deficiency and of
carrying out tests on the siblings and children of such carriers (despite
the fact that the deficiency appears to become clinically apparent in only
about 10% of patients with the deficiency)
David L Williams
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Anne Tarn
Sent: 14 July 2003 14:27
To: [log in to unmask]
Subject: Investigation of patients with abnormal liver enzymes
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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------ACB discussion List Information--------
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community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
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