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Post Info TOPIC: Recent labs
garfield


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RE: Recent labs
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JLynch30 wrote:

My alkaline phosphate climbed from 125 to 175

My bilirubin climbed from 1.2 to 1.9

 

Reason for concern?

 Hi John,

During therapy my alkaline phosphate climbed from 105 to 145 and was back 8 weeks after EOT.

cheers



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JLynch30


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Just got my ast back it is down too.

from 160 to 140.

 

ALT and ast both down (not normal but lower)

Creatine normal

pro time normal

 

Just that billirubin and alp that is concerning....



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John   non-responder  

Undetected at week 2 on solvaldi/rib/interferon:  stayed through week 12 but virus came back as soon as I stopped.  on   Harvoni and ribravirin 24 weeks undetected after two. 8/2/15  12 week EOT  UNDETECTED!  SVR

1991-2015 RIP

 
JLynch30


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Any suggestions if my alp does not come down?  What a high Bilirubin and ALP a sign of?  I like to know what I am up against.

 

Thanks



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John   non-responder  

Undetected at week 2 on solvaldi/rib/interferon:  stayed through week 12 but virus came back as soon as I stopped.  on   Harvoni and ribravirin 24 weeks undetected after two. 8/2/15  12 week EOT  UNDETECTED!  SVR

1991-2015 RIP

 
mallani


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Hi John,

I don't have cirrhosis either, if you believe Ultrasound, CT and MRI.  Compared with studies done up to 20 years ago, I can convince myself the liver is a little enlarged ( but still within normal limits) and my liver parenchyma may be a little denser. However I was F3-4 on biopsy in 2000, and F4 by Fibroscan in 2008. Imaging changes are not convincing until cirrhosis is well advanced. Then you see the uneven liver surface, the nodularity and the scarring.  Cirrhosis is notoriously difficult to diagnose on conventional imaging.  I hope your ALP continues to drop- it was probably just a 'flare'. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
JLynch30


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Thanks for the quick reply.

 

My alt actually came down a bit - from 160 to 145.  I have not got my ast back yet.   I had a ct scan two months ago and it showed no cirrhosis.   My doc said she is not too concerned with the high levels but will retest in  month.  I know these numbers jump but my Bilirubin (1.9) and alp (175) has never been that high.

I was all set to start an interferon free  trial but they pulled the plug because I tried bms700 three years ago.  

 

 



__________________

John   non-responder  

Undetected at week 2 on solvaldi/rib/interferon:  stayed through week 12 but virus came back as soon as I stopped.  on   Harvoni and ribravirin 24 weeks undetected after two. 8/2/15  12 week EOT  UNDETECTED!  SVR

1991-2015 RIP

 
mallani


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Hi John,

Alkaline Phosphatase (ALP) should be interpreted along with the other LFT's such as GGT, AST, ALT, bilirubin and albumin.  If the ALP is elevated, the other LFT's should also be elevated if the elevation is due to liver disease. It is released from damaged hepatocytes but is particularly associated with blockage of bile e.g. from gallstones or scarring from cirrhosis.  What are your other enzymes?  For ALP, my Lab uses a normal range of 35-110 U/L.  I was always slightly elevated ( around 120-130) but this is common in cirrhosis.  Since EOT my ALP is normal (80-90).  Elevation in ALP should be taken seriously, particularly levels of 175. What does your Hepatologist suggest? It may indicate that you are having an acute inflammatory stage. Keep us informed.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
mallani


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Hi John,

The ALT should be higher than the AST.  When AST:ALT ratio is >1, that is a pretty good sign of cirrhosis. Typically in chronic HCV , the levels are x 2-3 normal. Bilirubin can be x2 normal.  Anything higher than this is probably an acute flare.  In cirrhosis, a steady rise in levels is not good and suggests decompensation. This will always be accompanied by elevated bilirubin and ALP.

The APRI score has been used for years, to supposedly predict the liver fibrosis stage.  Using an APRI ( AST Platelet Ratio Index) score of 1.05 as the cut-off between mild (F0-F2-3) and severe (F3-,F4), some Hepatologists believe this is as good as biopsy. I don't.

The natural history of chronic HCV is not static, and there are numerous 'flares' when the LFT's ( and VL) can spike. You can drive yourself nuts worrying about fluctuations. Cheers.

 



-- Edited by mallani on Thursday 24th of October 2013 04:01:20 AM

__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
JLynch30


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My alkaline phosphate climbed from 125 to 175

My bilirubin climbed from 1.2 to 1.9

 

Reason for concern?



__________________

John   non-responder  

Undetected at week 2 on solvaldi/rib/interferon:  stayed through week 12 but virus came back as soon as I stopped.  on   Harvoni and ribravirin 24 weeks undetected after two. 8/2/15  12 week EOT  UNDETECTED!  SVR

1991-2015 RIP

 
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