Is AST level of 53 a cause for concern?

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Posted on Wed, 23 Aug 2017 in Liver and Gall Bladder
Question: I just had my annual physical last week and I have some questions about my results.

Ast level of 53 and normal alt level of 26. I have elevated bilirubin, have had it since I started doing physicals four years ago, it was 2.5 at this visit and fluctuates between 2.1-2.5.I do not have any signs of jaundice.

I also was just diagnosed with mild anemia. My Hgb is 12.1. I had high RDW around 19 and my MCV, MCH, and MCHC were all normal, RBC was 3.76. WBC was normal. I am fairly healthy, I work out four days a week three days with weights and one for cardio and maintain a decent diet. My Dr is having me perform fecal tests at home to determine if I have blood in my stool. I have done an at home test from Walgreens and it has come back negative for blood.

At the end of XXXXXXX i came down with some type of sickness which caused fever, joint, pain, coughing, chills etc. I had that twice in one week. The week of my routine physical I had diarrhea for three days along with stomach cramps and nausea. I do not have any obvious symptoms of anemia. I do not feel fatigued, shortness of breath, etc.

1. How concerned should I be with my AST level? My DR stated it is due to fatty liver but I rarely drink. Maybe 8 beers a month.
2. How concerning is the mild anemia and is there a correlation between the anemia and my liver function test?
3. My Dr has never expressed concern over my elevated bilirubin, but is there a correlation between that and my mild anemia?

doctor
Answered by Dr. Shuba Hariprasad 2 hours later
Brief Answer:
Further clarifications please.

Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.

Would you clarify a few things for me, please?
*what is your height and weight?
*do you have any other medical issues or take any medications? Including otc meds.
*is this first time that you have had diarrhea with cramps and nausea in the past year?
*do you still have fever and joint pains?
*did you do other blood tests like kidney function tests (urea, Creatinine, electrolytes)?
Which of your bilirubin was elevated - conjugated or unconjugated bilirubin?
*have you any endoscopy/colonoscopy or ultrasound done?
*what colour are you stools and urine?
*do you smoke?
*do you have any family history of inflammatory bowel disease, other auto immune disorders or cancer?

I recommend :
-a gastroenterologist opinion.
-an ultrasound abdomen
-blood tests as mentioned above, if not done.
-an MRCP, endoscopy if clinically indicated.

It is highly likely that the anemia and hyperbilirubinemia are related.
Hence, It is important to find out the cause of anemia, although not severe.
There is a possibility of intrinsic liver disease or mild obstruction as well.
Fatty liver can be caused by reason other than alcohol resulting in no alcoholic fatty liver disease.

Please get back to me with the above requested clarifications so that I can advice you further.
Warm regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Shuba Hariprasad 13 minutes later
I am 5'8 165lb male. No otc medicines, no history of inflammation, my grandmother did have leukemia around the age of 63. Yes this was the first time I had cramps and diarrhea in the past year my wife had it as well. Dont smoke, stool is normal color, urine is usually clear to light yellow. No fever or joint pain anymore. They did not test for conjugated or unconjugated. All of my labs for the past four have been good till this one, so my Dr thought I had Gilberts syndrome. I have not had an ultrasound or endoscopy or colonscopy done,

I did speak to one gastroenterologist on this site and he told me that the anemia and ast levels were nothing to worry about but to find out why I have elevated billirbuin.

sorry they did creatine test and electrolytes and they were normal
doctor
Answered by Dr. Shuba Hariprasad 10 hours later
Brief Answer:
Please investigate the cause of high Bilirubin and RDW

Detailed Answer:
Hello,
Thank you for the follow-up.
Sorry for the delay in replying.

Yes, the gastroenterologist was right. AST levels and haemoglobin levels are not in the range of concern. However, I prefer to not just take individual tests and lab reports alone into concern.

As a whole, your bilirubin level is high and other causes (other than Gilberts) needs to be ruled out or gilbert's disease needs to be confirmed.

Our body responds subtly to certain underlying problems. It may most likely be nothing but under the circumstances, with all advancement in health care & diagnostic methods, it is better to be sure.

If it indeed is gilbert's disease, then it can be left alone with awareness of certain precautions to be taken to protect the liver.

Your Rdw is high with normal MCV. This could happen in iron /folate deficiency, chronic liver disease & certain other condition.

Your height and weight are fine. As I mentioned in my earlier response, it is better to investigate the cause.

Have an abdominal ultrasound, check the blood urea levels and see which bilirubin (conjugated or unconjugated one is higher).

Hope this helps and I've answered your query.

Please let me know if you have any further queries.

Wish you the best of health.
Regards,
Dr. Shuba Hariprasad

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Shuba Hariprasad 14 minutes later
Not a problem on the delay. Thank you for the detailed response, it makes me feel a bit better. I am calling my DR on Monday to schedule the bilirubin test. I cant believe in four years I never had a test for direct and indirect given my bilirubin has always been elevated above normal.

I did forget to mention one thing you brought up IBS. Ever since I was a kid I would occasionally get severe cramps. They could last for hours and I would have to sleep for a couple of hours afterwards and usually have a bowel movement. I just figured it was intense gas or a reaction to something I ate. I still get them from time to time the most recent being when I was sick a couple of weeks ago. Could this be related to anything I am experiencing with my lab results?
doctor
Answered by Dr. Shuba Hariprasad 22 minutes later
Brief Answer:
Yes, check for sickle cell disease as well

Detailed Answer:
Hello,
Yes, it is possible.

Sickle cell disease can also cause similar symptoms and lab results.
Mild anaemia, severe cramps and bouts of diarrhoea, elevated bilirubin levels.

However, it is common to see more severe symptoms and from a younger age.
Checking for haemoglobin S in your blood can rule out this condition.
I'm glad to be of help.
I'd appreciate a feedback if you feel our discussions been helpful.

Thank you and hope you get the proper diagnosis at the earliest.

Wish you good health.
Regards,
Dr. Shuba Hariprasad


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Shuba Hariprasad 56 minutes later
Last question. My bilirubin has increased over the years from 2.0 to 2.1 to 2.4 and now 2.5 while everything else has remained normal till just now. If this was due to liver disease would I have had symptoms over the past four years? And if it was due to an obstruction would my bilirubin be higher and would I have symptoms as well? Lastly since it has increased every year with no other symptoms or abnormal lab values would that be why my Dr has never done direct or indirect tests?
doctor
Answered by Dr. Shuba Hariprasad 23 minutes later
Brief Answer:
Please see detailed response

Detailed Answer:
Hello again,

To answer your queries:
1) it is possible to have liver disease with subtle or no symptoms (asymptomatic).
Subtle signs include unexplained fever, abdominal pain, diarrhoea, fatigue.

Obstruction of bile, however, is usually more evidently symptomatic with an occasionally asymptomatic presentation. Symptoms are similar to this mentioned above but with a higher intensity and the presence of jaundice (yellow discoloration of skin and mucosa membranes).

LAB values too will be more deranged.

2) the total bilirubin level is the total measure of the conjugated and unconjugated bilirubin put together.
This is usually the first thing to look at (as to which one is higher) to narrow down the possible diagnosis.

So I do not understand why this differentiation was not done. It is possible that it was done but your doctor didn't mention it specifically.

For instance,
In Gilbert's disease, unconjugated bilirubin will be higher and the conjugated lower than or equal to normal value.
Hemolysis will result in both being raised but more so the unconjugated one.
Liver damage due to medications can lead to a similar picture.

The diagnosis of Gilberts is made after ruling out obstructive, Hemolytic and liver cell damage.

ALT & AST are enzymes produced in the liver. This can be slightly raised or normal in a chronically affected liver due to cell damage producing an ineffective response.

An ultrasound abdomen can correlate the physical examination findings with blood reports and your medical history.

Possibilities are many but the good news is you are healthy.Plenty of resources are available to find out the cause of increased bilirubin.

A suspicion of Gilbert's disease is only a possible diagnosis, not the Final diagnosis until it has been proven so.

All I suggest is that you discuss these points with your doctor. I'm sure they will guide you appropriately. If necessary, early treatment will help. If not, at least you will be reassured that there is nothing to worry about.

Hope I've helped and answered your queries to your satisfaction.
I'd be happy to help with any further queries you may have.

Best wishes
Dr. Shuba Hariprasad

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Shuba Hariprasad 52 minutes later
One more question, what low Platelet count. Mine was low is this a byproduct of my mild anemia? I looked at my past labs and they were also on the low side but not below normal. Normal is 150 and I was at 121
doctor
Answered by Dr. Shuba Hariprasad 1 hour later
Brief Answer:
Yes it is possible that they are related

Detailed Answer:
Hello,
Do you mean to say that this time around your platelet count has dropped below the normal range as compared to those earlier?

*Have you done a prothrombin time test?
*What is your white cell count?

Low platelets has many causes including stress on the body like infecte, autoimmune disease, chronic liver disease, iron/folate deficiency.
It may be associated with anemia but not necessarily.

Looking at the whole picture... In your situation, chronic liver disease needs to be ruled out.

An ultrasound abdomen to check for liver size and texture and blood tests as mentioned earlier need to be done.

Please let me know if you have any further queries.
Warm Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Shuba Hariprasad 29 minutes later
Yes compared to past results it is below normal my MPV is normal as is my WBC I have not done a prothrombin time test. Will I have to be referred to a specialist for the ultrasound?

Could my bouts I had with the two or three viral infections over the summer contribute to low platelets?

WBC is 4.4 normal is 3.4-10.5. Is there a correlation between liver disease and decreased platelets?
doctor
Answered by Dr. Shuba Hariprasad 3 hours later
Brief Answer:
Yes, low platelets is commonly associated with liver diaease

Detailed Answer:
Hello Sir,
1)if it has been more than 4 months after your last viral infections, it is unlikely to be due to this, that your platelets are on the lower side.
After a severe viral infection like influenza, dengue, to name a couple, the platelets reduce as can red and white blood cells.
This usually normalizes within 3-4 months after the infection.

2)yes, a sonologist usually performs and ultrasound scan. However, certain physicians also provide this imaging. Talk to your physician about this.

3)liver disease is commonly associated with low platelet count but is not the only condition where this happens. As your bilirubin is elevated, it is the first possibility to rule out.
Your doctor may also refer you to a hematologist (specialist in blood disorders) to have an additional expert opinion.

If the liver & biliary system is normal in the scan & clinical examination in addition to blood tests, other causes like hemolysis, nutritional deficiencies, bone marrow disorders will be checked for.
This might be overwhelming for you. I am only trying to give you an idea of how the course of investigation may proceed and am not telling you that you have these conditions. Hope you understand.

Please let me know if you have any further queries.

Wish you good health.
Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Shuba Hariprasad 12 minutes later
I understand. I had the first viral infection around XXXXXXX 28 and the second one around July 25. The first one lasted over a week and the second about 3 days. I had my exam on July 28. Should I also be concerned about any issues with my pancreas?

I have been doing too much research on my lab results and I have kind of freaked myself out with some of the information I have found.
doctor
Answered by Dr. Shuba Hariprasad 14 minutes later
Brief Answer:
Don't worry now. Take it one step at a time

Detailed Answer:
Hello,

Yes, I thought so, from your questions, that you have been doing a lot of thinking and worrying about this.
I am sure I would have done then same.
However, as it is the unknown that we fear, understand that, as of now, everything is fine until proven otherwise.
You are now aware of the possibilities. Pancreatic involvement, in fact even the gall bladder can be involved. However, if there was anything to worry about, your instincts and body would tell you so.

The bilirubin & other reports are incidental finding and a chance for you to know what's happening. It has an equal chance of being benign and nothing to worry about but we shall be sure and not ignore it.
Yes, if your viral infection was severe, these episodes can lower your platelets.

Take it one step at a time. Write down your concerns and list out what you want to know and intend to do about them. Seeing it on paper will help you deal with it better rather than going in anguishing circles within your mind.

Repeat blood tests, additional tests (type of elevated bilirubin, urea, prothrombin time, peripheral smear, lactate dehydrogenaseevels, differential white cell count, hemoglobin S, genetic test for gilbert's disease, ultrasound abdomen, stool analysis for parasites) are some options which will decided upon by your doctor. Not all will be necessary, may need different tests.

So, one step at a time and do not dwell on the anxiety of not knowing. The stress will get to you.

Hope this helps.
Please let me know if there is anything else I can help you with.
Regards,
Dr Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Shuba Hariprasad 31 minutes later
You were great. I appreciate you taking the time to answer all of the questions I posed to you. I am going to try and not worry. I haven't slept in two days and I'm so tired. Again thank you. And I might follow up with you after I start down this road; depending on how things go.

Thank you XXXXXXX
doctor
Answered by Dr. Shuba Hariprasad 19 minutes later
Brief Answer:
Most welcome

Detailed Answer:
Hello,
I'm glad that you have come to this decision.
Yes please rest and do the needful.

I'd really appreciate an update and would be only happy to follow up.

Warm regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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