• February 9, 2016
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Author Topic: Interpreting liver enzyme tests  (Read 757 times)
treehugger1
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« on: January 26, 2016, 11:50:32 pm »

I started immunosuppressant therapy with Azathioprine (Imuran) about 3 1/2 weeks ago. My ENT was perfectly happy to just put me on the medication and see me again in a couple months' time. I read however that this drug was associated with hepatotoxicity in some patients, particularly at the beginning of treatment, so I asked my PCP if we could set up a weekly blood test to monitor the liver enzymes, blood count, etc.

I have had two tests so far. The first blood test came back completely normal except for mild elevations of two liver enzymes -- AST and ALT.  AST was at 45, where normal for this lab is between 10-35 U/L. ALT was at 43, where normal is between 6-29 U/L.  The second test again came back normal except for even higher readings for these two enzymes. AST is now 63 and ALT is at 74. In other words, AST is now close to double the upper limit of normal and ALT is over 2x the upper limit of normal.

According to the nurse, my PCP thinks I should continue the medication in spite of the elevated readings  as long as I am feeling fine, have no side effects and am asymptomatic. I will see the PCP in a couple of days and hopefully get some clarity on this matter. But for the time being, I am seriously wondering what on earth is the point of having these tests run, if he's just going to ignore the abnormal results until I start feeling the results of the liver toxicity. Isn't that the whole point of testing? To figure out what is gong wrong *before* it becomes a crisis or before I feel ill from the liver damage.

Help me here. What is it that I am not seeing?

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little_girl_lurking
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« Reply #1 on: January 27, 2016, 11:34:58 am »

Most doctors will let the AST and ALT numbers get pretty high (2-3x normal) when you're on a drug known to raise those numbers before they take you off the drug.  Statins do this, I know.

In the absence of actual symptoms of hepatic impairment, those numbers would generally return to normal once you discontinued the drug, and thus are not markers of any damage.  If they drifted too high (like an AST greater than 3x normal), they would in fact discontinue the drug, which is why they test you so often.

« Last Edit: January 27, 2016, 11:35:16 am by little_girl_lurking » Logged
bunnicula
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« Reply #2 on: January 27, 2016, 11:40:08 am »

"Normal range" doesn't necessarily mean that numbers outside of that range automatically cause damage, just that it is a range that most people in the population fall into.
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little_girl_lurking
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« Reply #3 on: January 27, 2016, 1:00:55 pm »

"Normal range" doesn't necessarily mean that numbers outside of that range automatically cause damage, just that it is a range that most people in the population fall into.
Yes, this.   That's what I was trying to wrap my brain around.
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treehugger1
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« Reply #4 on: January 27, 2016, 5:26:30 pm »

Thanks! I spoke with my ENT over the phone and that's more or less what he said. He thought that those numbers were still OK, but if they were again significantly higher next week, then we'd talk about switching drugs, reducing dosage, etc.

I have a friend who is a terrific patient. Her motto is just get a doctor you really trust and do whatever they say. Somehow I seem constitutionally unable to do this. Would be nice and relaxing though.


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little_girl_lurking
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« Reply #5 on: January 27, 2016, 5:58:14 pm »

Thanks! I spoke with my ENT over the phone and that's more or less what he said. He thought that those numbers were still OK, but if they were again significantly higher next week, then we'd talk about switching drugs, reducing dosage, etc.

I have a friend who is a terrific patient. Her motto is just get a doctor you really trust and do whatever they say. Somehow I seem constitutionally unable to do this. Would be nice and relaxing though.



Oh it would be nice to be that person!  I'm the person who's out there trying to read the peer-reviewed literature about whatever course of treatment I'm doing/considering (despite my total lack of medical credentials).  But then again, I have had some really fun doctors who encouraged that.
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