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Old 07-12-2012, 07:39 PM   #1
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Lab Interpretation

30 yo Male

BUN = 8 - (9-20 optimal)
Creatinine = 0.88 - (0.66-1.25 optimal)
Albumin = 4.6 - (3.5 - 5 optimal)
Bilirubin = 1.6 - (0.2 - 1.3 optimal)
ALK PHOSPATASE = 75 - (38-126 optimal)
ALT = 12 - (21-72 optimal)
AST = 41 - (17-59 optimal)
Cholesterol = 199 - (Less than 210 optimal)
Triglyceride = 69 - (30 - 150 optimal)
HDL = 62 - (40-60 optimal)

is there anything to worry about liver wise? My doctor just said if you do not hear from me everything is good, but based on these results, my BUN is low, my BUN/Creatinine ratio is low, my Bilirubin is high, my ALT is low, my HDL is high.

Is that really nothing to worry about?

Last edited by Bob8282; 07-12-2012 at 07:42 PM.

 
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Old 07-13-2012, 07:24 AM   #2
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Re: Lab Interpretation

When a single blood lab snapshot has a couple of values that are off by relatively minor amounts, doctors don't usually sweat the small stuff unless there are symptoms or other clinical signs that are also indicating a possible problem or disease process.

What multiple minor lab anomalies do indicate is a rationale for a follow-up study, typically done in 90 days to see if these anomalies are "persistent" or "trending" further into out of range territory. When multiple labs are out of range over a series of tests done over time, additional diagnostics may be indicated to find out why this is occurring.

Body hydration at the time blood is drawn can often throw many lab values off by moderate amounts, and this might explain minor moves out of range. If your blood draw was a morning "fasting" blood draw, you may have been a bit dehydrated when you went in for the test. If blood is drawn in the afternoon, after a salty fast food lunch and a substantial amount of fluid to drink, you may have been a bit over-hydrated causing some values to swing slightly out of range too.

If you do a follow-up test, try to normalize your hydration before you go for your blood draw. You are usually allowed to drink water before a fasting draw, so try doing this. Don't over-do it and flood your body with fluids, but drink enough to start producing some urine before the draw. If you're going in later in the day, watch your sodium intake and try to have blood drawn when you are "normally" hydrated.

Hope you get green lights right down the line with your next test!

 
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Old 07-13-2012, 08:20 AM   #3
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Re: Lab Interpretation

What worries me the most is the AST/ALT ratio, along with the high Bilirubin. Does the AST/ALT ratio matter if both values are in the Normal range? Or is that ratio only used when values are elevated?

 
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Old 07-13-2012, 08:48 AM   #4
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Re: Lab Interpretation

Why were these tests ordered to begin with? Is there a concern based on symptoms or history with your liver? The BUN being borderline low might just be from slight overhydration. High bilirubin in this range can be from a hereditary enzyme deficiency and is benign but can cause visible jaundice in the eyes when fever, exhaustion, dehydration or illness occurs. It is common in young males and is called Gilbert's diease, even though it is not really a disease. I am not saying that is what it is, only mentioning it as a possibility for reassurance. Usually low ALT and AST are not concerns, it is when they are high that one worries. I would recommend a follow-up and a complete blood count to make sure you are not anemic and breaking down red blood cells causing the bilirubin to be up, called hemolysis. Any symptoms, such as pain or weight loss, should be pursued as well.

 
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Old 07-13-2012, 08:53 AM   #5
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Re: Lab Interpretation

Quote:
Originally Posted by ladybud View Post
Why were these tests ordered to begin with? Is there a concern based on symptoms or history with your liver? The BUN being borderline low might just be from slight overhydration. High bilirubin in this range can be from a hereditary enzyme deficiency and is benign but can cause visible jaundice in the eyes when fever, exhaustion, dehydration or illness occurs. It is common in young males and is called Gilbert's diease, even though it is not really a disease. I am not saying that is what it is, only mentioning it as a possibility for reassurance. Usually low ALT and AST are not concerns, it is when they are high that one worries. I would recommend a follow-up and a complete blood count to make sure you are not anemic and breaking down red blood cells causing the bilirubin to be up, called hemolysis. Any symptoms, such as pain or weight loss, should be pursued as well.
They were just part of my normal physical. I have lost 35 pounds in the last 4 years, but I exercise 10-12 hours a week. Also, I had a completely normal Ultrasound of my liver 2 years ago (size and echogenicity). They were looking at my gallbladder, which was also normal. My entire upper abdominal ultrasound came back fine.

I drink maybe 2-3 beers a day (although I am going to stop now with these results), which is why I am asking.

Last edited by Bob8282; 07-13-2012 at 08:54 AM.

 
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Old 07-13-2012, 09:13 AM   #6
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Re: Lab Interpretation

An AST/ALT reversal can be a red flag for liver problems, especially when this occurs when they are both high and the patient has a long history of heavy drinking, Hep-C or other contributing factors.

Yours are both in range, or very close (the slightly low ALT) and AST can be boosted over ALT briefly by exercise or exertion as muscles produce AST enzymes when they are stressed too.

With bilirubin, it is helpful to have this broken down into the "direct" and "indirect" bilirubin factors. Elevated direct bilirubin can indicate sluggish lack of bile movement through the liver and gallbladder, while elevated indirect bilirubin can indicate liver cell dysfunction.

Again, if you were dehydrated when blood was drawn plasma is more concentrated and things like bilirubin may appear slightly high on results when in reality your fluid/hydration balance was really slightly low. Your's is so close I wouldn't see it as a cause for alarm if you have no symptoms, but this is something to follow next time you have labs done.

If you go back to your doc now and ask for more testing (direct/indirect bilirubin) he may be a bit exasperated as your current tests are so close to normal. If you've got symptoms going on, or other disturbing clinical findings, that would be another story.

If you're feeling fine, I would sit on these labs for 3 to 6 months and then pester your doc for a follow-up to see if your anomalies are persistent or trending further out of range. You can request both direct and indirect bilirubin be measured at this time, and they might want to throw in a GGT liver enzyme test which is a good indicator of inflammation that might clear up whether it's your liver or something else causing your AST/ALT flip.

 
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Old 07-13-2012, 09:22 AM   #7
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Re: Lab Interpretation

Thanks, I will stop drinking all together for that time period, and make sure I am hydrated for the test and check again in 3 months (if I can wait that long, this is playing with my head).

 
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Old 07-13-2012, 09:45 AM   #8
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Re: Lab Interpretation

Ladybud made a great call on the Gilbert's... Your workouts may be contributing to hemolysis and a mild elevation in bilirubin too, especially if you jog.

Red blood cells are actually quite fragile, and jogging can produce "heel strike hemolysis" as your heels hit the pavement and damage blood cells by the repeated shock and pressure loading.

Your workouts are also likely to raise your AST higher in the normal range and push it over your beautifully low ALT too as muscles are stressed.

Looks like we've figured out a likely explanation for most of the kinks in your otherwise beautiful labs. If they still look this good when you're 60, you'll be a lucky guy!

Stay Healthy!

 
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Old 07-31-2012, 09:30 AM   #9
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Re: Lab Interpretation

Well, I did the re-test. Everything came back normal liver wise. The only thing high was Bilirubin, but they said some people just have high counts. I do, however,have a whole new set of problems to worry about. Here are the results:

BUN = 9 - (7-25 optimal)
Creatinine = 0.94 - (0.66-1.25 optimal)
Albumin = 4.5 - (3.6 - 5.1 optimal)
Bilirubin = 2.0 - (0.2 - 1.3 optimal)
ALK PHOSPATASE = 40 - (40-126 optimal)
ALT = 15 - (9-60 optimal)
AST = 18 - (10-50 optimal)
Cholesterol = 160 - (Less than 210 optimal)
Triglyceride = 64 - (Less than 150 optimal)
HDL = 56 - (Greater than optimal)

This time, however, they did a CBC. My WBC came back at 3.1, and my Platelet count came back at 139. My Absolute Lymphocytes were low, and my Absolute monocytes were low. They want me to do another CBC in 1 month. Anyone have any ideas what this means?

Last edited by Bob8282; 07-31-2012 at 09:31 AM.

 
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Old 08-01-2012, 12:55 PM   #10
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Re: Lab Interpretation

Any ideas?

 
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Old 08-01-2012, 01:15 PM   #11
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Re: Lab Interpretation

The low WBC and slightly low platellets, as well as the low lymphocytes can be seen in autoimmune disorders, like lupus. Lupus could be causing hemolysis (breakdown of red cells) as well, causing the bilirubin to be elevated. I would first get a direct/indirect breakdown of bilirubin, a Coombs test to check for antibodies causing hemolysis, and an ANA blood test for screening. None of these results are going to cause you serious issues, but it would be important to find out why you have these abnormalities showing up. Platellets can go low in lupus as well. I would also ask for a urine check to be sure there is no protein or blood in urine. I don't think this is a liver problem. Any history of autoimmune disease in your family? Be sure to relay that info to Dr. as well. You don't have to wait a month either. You could get these done now while this is showing up, as sometimes, the symptoms/signs of AI disorders is transient. May be gone in a month and not as easy to identify.

 
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