Brandnewmom
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re LFTs
editThanks for question, and yes you are correct, I can't give a diagnosis or offer direct personal advice. The results should be discussed with your child's doctor in the next few days (telephone or face to face visit). Slight rises are not an emergency nor urgent in themselves – but must be taken into consideration along with the condition of the child (a happy child who seems better, from whatever illness they had had that prompted having the blood test, is clearly not of much concern, unlike a child whose unexplained illness is deteriorating)
Obvious points (these are rhetorical, and no reply is sought):
- why were the tests done in the first place - i.e. do they explain the problem being investigated or seem incidental findings
- is the current treatment having a mild and insignificant effect on the liver - many drugs are quite normally inactivated by the liver and a blood test may merely reflect this
- how slight is "slightly elevated" ? - Most tests are arithmetically assessed, hence if normal range for haemoglobin level is 12-16 then 11 is a mild drop and 10 is doubly so into anaemia. However for most liver enzymes it is the geometric multiplication that is considered in interpreting adult results (I am not experienced in how children's results are evaluated), hence an ALT with normal range 0-40 (in my local laboratory), means 60 is a mere x1.5 the upper limit of the normal range and 80 is x2. Generally liver enzyme results (ALT, AST and gGT, but not the level of bilirubin) up to x2.5-x3 is considered slight-mild, up to x5 mild-moderate, and over x10 severe. So a result of 41 is only a trivial amount over the reference range - but also consider points below:
- how does this result compare to previous - if all previous results when the person was well are similar to the current result, then this may just be a normal variation of results for that patient. When one discusses "the normal range", the word "normal" is not being used in its common usage of "correct" or "healthy". Instead it is being used in the mathematical statistical meaning of a certain spread in values from the average ("norm"). Typically a spread of 2 standard deviations either side of the average is taken which will include about 95% of all healthy persons. However this means that there will be 5% of healthy people outside of this artificial range who risk having harm done to them (emotional worry or physical hurt) if their doctor needlessly over investigates this. Of course outside of the normal range will appear most (but not all) people with an illness. Hence whilst the normal height for an adult man might be 5foot 6 inches to 6foot, someone who is 6foot 1inches is not viewed as abnormal or needing unpleasant and potentially dangerous tests. Yet someone 7foot 6inches probably does need checking for hormonal disorders.
- Is there a trend in the results. A steady rise in results over several readings is clearly showing a trend. Hence, returning to ALTs (range 0-40), sequence of 10, 17, 14, 15, 28, 38, 45 clearly has something happening over the last 3 readings, whereas 36, 40, 37, 42, 35 clearly is essentially unchanged and averaging just below the upper limit of the normal range. Of course any single individual's liver function will naturally alter slightly from day-to-day, and the analysis of any single sample repeatedly put through a laboratory's analyser will give small margins of error for each measurement.
- Take results in context of the clinical picture. Example: an ill looking child has their temperature taken and it seems high – but if by the time one has looked up in a book what the normal range for a child's temperature should be, the child no longer looks red and dopey and is up & running about playing normally, then the recording of the high temperature was both clearly a temporary feature (presuming children happily playing do not have very high temperatures) and did not predict increasing illness (the child's illness has clearly self-resolved).
- So an ill child who has blood tests taken that come back (after some hours or days) as slightly elevated - the obvious first question is "how is the child now ?" If the child is better then probably any abnormal findings are now settled (but clearly may need rechecking to be certain), whereas a child who is worse may now have test results that are even more abnormal than before and in need of prompt rechecking.
In essence you need the significance and the interpretation of the test results explaining to you by your child's doctor, the tests may or may not need to be repeated to look to see if there is a trend. Small elevations of liver enzyme results are not in themselves an emergency nor urgent, but (assuming your child's condition is not giving rise to increasing concern) need routine discussing with your doctor in the next few days. Hope you get the explaination you seek and your child remains well :-) David Ruben Talk 23:23, 19 October 2006 (UTC)
- How rude of me - I should have started the above with:- 'Congratulations on being a "Brand New Mom"' :-) David Ruben Talk 23:26, 19 October 2006 (UTC)