Raised ALT in 10 wk old following prolonged jaundice

[splodge2001]

Having a bit of a stress! If anyone knows anything about pediatric hepatology or has had experience of this I'd be really grateful for their input.

DD had prolonged jaundice which resulted in a blood test at 4 wks. Total bilirubin was 115 and conjugated bilirubin was 8, hence a diagnosis of breastmilk jaundice - all well and good - BUT the consultant said she had midly raised ALT at 53. Their cut off is 50. He wasnt too worried BUT two of my uncles died of non alcohol cirhosis and my dad has always had raised bilirubin SO....

The test was repeated last week and the ALT was further raised to 60, so we have another test next week. It has been suggested there may be something inherited like Alpha-1 antitrypsin deficiency but having researched like mad on the internet it looks like if she had this she would have had cholestatic jaundice and not the breastmilk type.

Anyway if its not this alpha-1 thingy, could it just be nothing. she seems entirely healthy, normal stools and urine and really smiley and well.

can anyone shed any light?

[blondissimo]

I'm sorry I have no idea but it must be very stressful for you so bump for you and hopefully some medical professionals are reading this .
Hope she is better soon x

[alkar]

First off if alpha-1-antitrypsin def is suspected, then why haven't they measured it itself? It can also be inherited, is there a family history of it?

Secondly lots of other factors can raise your ALT level. If the dr has had trouble getting the sample the red cells can lyse and release ALT, also haemolysis, delay in sample analysis or even if the sample was in a warm place beofre it got to the lab can affect things like ALT and potassium.

[splodge2001]

Thanks alkar. Are you a doc?
no history of Alpha-1 just two dead uncles mentioned and my DF with dodgy liver function but otherwise symptomless. Ive always had very good liver function - got it checked whilst pregnant with DD coz of suspected cholestasis - i didnt have it, just ordinary itchiness.

dd has had two tests now 1 - 53, 2-60

they are pretty close so i guess that rules out the possibility that it was raised because of poor handling or extraction?

There is nothing else strange in her results and the only weird thing - if you can call it weird was that she was still a bit jaundiced at 6 weeks. could the jaundice have caused the ALT to go up?

[alkar]

I'm a biochemist. The only thing I can see in my books at home is that a slightly raised ALT can be expected in a newborn. I don't think there will be anything to worry about with just a slightly raised ALT, do you know what the results of the rest of the liver profile were? If it is alpha-1-AT def then you should know more when they test the alpha-1-at, not many labs in look into the genetics of it but you will get a value for the alpha-1-at and they will do further tests based on that result.

[splodge2001]

Thanks again alkar.I only know that the other results are completely normal. I asked for the complete set of results but they didn't send them. We're going back on Friday for a repeat of the test and maybe they will do the aplha-1-at but im not sure why they are considering it when there has been no sign of cholestasis. Her liver is not palpable even.

I did find a research paper on isolated raised ALT in newborns. The babies all had higher ALT than DD and they all resolved within a year. I'm hoping she is part of the same phenomenon! Do you know why ALT can be raised in newborns?