Avatar universal

What do elevated ALT and lymphocyte levels mean?

2 months ago I went to doctor for a routine check and I went in a blood test. Some of abnormal results are as following:

RBC:   6.3
HCT:   %50.5
MCHC:   33.4,
WBC   7.8
Granulocytes: absolute count 3.8,  relative percentage %48.6,
Lymphocytes: absolute count 3.7,  relative percentage %47.7,
ALT:   66
AST:   22,
LDL:   115.8
Total cholesterol:   186
Triglyceride:   131
Vitamin B12:   208.

2 months later, new test test results:

RBC:   5.72
HCT:   %49.1
MCHC:   32.3
WBC:   6.4
Neutrophiles: absolute count  2.2,  relative percentage %34.4
Lymphocytes: absolute count  3.4,  relative percentage %53.1
ALT:    120
AST:   41
LDL:   139
Total cholesterol: 205
Triglyceride: 141
Vitamin B12:   272

Then my doctor suspected viral hepatitis. But no sign for viral hepatitis markers found.
HBs Ag (-), anti HBs 27.59 (+), anti HBc IgM 0.29 (-), anti HCV (-), anti HIV (-)

I am vegetarian for 2 years and suffering from seborrheic dermatitis for 8 months. I am not so physically active. I don't have any physical symptoms. ( Age 19, weight 75 kg, height 1.75 m.) What do all these results mean?
Best Answer
Avatar universal
These other systemic viral infections will vary in their symptoms. The main thing though is that the liver end of the symptoms tend to be secondary wrt getting the doctor's attention. These diseases will primarily affect the other parts of your body, so you might not even notice that your liver was also being affected. The two previous examples were just that, and I didn't mean to imply that you possible had them. I just wanted to point out the your doctor will likely have to consider things beyond the typical set of liver diseases.

And wrt AI liver diseases, anything is possible of course. It's just that your liver enzyme profile points to a viral attack, but this can sometimes be misleading. There's something called the De Ritis Ratio and doctors use it to give them hints as to what's up. In your case, your De Ritis Ratio is consistently 0.333 and 0.342, which points to a viral condition since this is substantially lower than 1.0.

And for example, if the De Ritis Ratio were to be around 2 or greater, then the patient would likely be dealing with an advanced alcoholic liver disease (probably alcoholic hepatitis). This isn't you of course.

Your doctor will need to do some auto-antibody blood tests to screen the AI possibilities. You can discuss this with him as well if you happen to know other members in your family that also deal with AI diseases.

I didn't want to mislead or worry you before, but that's why I included your neutrophil-to-lymphocyte ratio (NLR) earlier. It's a very crude marker that can be used to signal a possible malignancy issue. Again, it's very crude but your NLR needs to be at least around 3.5 (5 is a better threshold) before one would start thinking about "C" stuff. You're well below that as well so no worries.

And fatty liver disease is a possibility, many people have it now days. But your cholesterol numbers are normal. If you have clinically significant fatty liver disease, then your liver becomes enlarged and somewhat congested due to the steatotic portions of the parenhcyma taking up tp 50% or more of the space. This can impede your bile flow which transports your cholesterol out of your liver - and then your cholesterol numbers tend to rise.

Hope this help a little but your doctor seems to be on top of things. I'm sure he'll figure things out for you. We're just patients here with only general ideas about what's bothering our livers, not diagnostic stuff for sure. Take care.
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2059648 tn?1439766665
Hi there.  Do you realize that your B12 is really low.  That can make you feel
bad and cause problems.   I would talk to your doctor about that.
Helpful - 0
Avatar universal
Hi.I used b12 supplement for 1 months but it is abnormally too low. I am a ovo-lacto vegetarian so I also eat egg and diary products and they have enough b12. But it doesn't work well. And does that explain elevated alt and lymphocyte levels?
Helpful - 0
Avatar universal
Your numbers show several different health issues going on. The primary problem is likely a viral infection that is affecting your liver. And the other issues seem to be secondary to that.

Clearly your liver is being inflamed and this is most likely due to an acute viral disease. This is indicated by the levels of your two principle liver enzymes: Alt and Ast. This would usually indicate an infection of viral hepatitis A, B, C or E - but you've had those tests done and proven clean. So this means your likely dealing with a currently untypeable viral infection. Some of these other systemic viral infections (like cytomegalovirus, Espstein-Barr, etc.) can also attack the liver, but the hepatic portion of these infection is considered secondary.  So hopefully your doctors maybe able to diagnose your current condition with some additional, non-standard tests.

Your dermatitis issue may also be due to your liver problems. Hepatobiliary issues have been known to cause seborrheic dermatitis. If the timing seems to support this, talk to your doctor about this possibility. It may simply resolve itself, once your viral infection has run it's course.

The differential shift of your lymphocyte count is also likely related to your liver infection. The numbers only show a mildly increased bias, so there isn't much of a concern. And the neutrophil-to-lymphocyte ratio (NLR) is low, below 3.5, so there's nothing in your white blood cell profile that indicates anything other than your infection going on.

It would seem you're very active as well, you can see it reflected in your cholesterol levels. The HDL's are the good guys, and the LDL's are the bad guys. And exercise is a great way to keep your HDL levels up. So your Total Cholesterol -to- High Density Cholesterol ratio is 3.1, which is lower (low is good) than the 3.5 optimal ratio threshold.  Your Vitamin B12 is also normal, greater than 200 pg/mL. Your doctor will be pleased.
Helpful - 0
Avatar universal
Thank you for your response. First of all,  are there any other symptoms of those systemic viral infections? Second,  could it be a autoimmune disease or a cancer that causes this results? By the way, can such a cholesterol level turn my liver to fatty, I mean particularly non-alcoholic fatty liver disease?
Helpful - 0
Avatar universal
I had an appointment with my doctor today. He also has difficulty in understanding my test results. He wanted me to get tested for autoimmune hepatitis. And I will perform a hepatobiliary ultrasonography. But he said he don't think that it's an autoimmune disease because it is really a rare condition. I asked him about other types of systemic viral infections but he said it has nothing to do with other viral infections. He also added they will find out what's going on in my body as soon as possible and said don't worry. But it's really hard to deal with it. I can't wait, it's annoying. My new blood results will be available on thursday and I am scaring of having such an AI condition. I searched a bit about it and It is a life-threatening condition. Even I may have to perform a liver transplant if I have AI.
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Avatar universal
Your doctor is doing a good job and working through the differential process. It's difficult to pin this stuff down sometimes. As I mentioned previously, your initial blood numbers pointed to viral problems. Your doctor feels that he's exhausted that end of the diagnostic list so now he's looking for more clues. It took my team of doctors six months before they figured out what my hepatobiliary system was up to. Hopefully this won't take as long in your case.

Let us know how your new blood work turns out. If it is AI related, then he's likely to be able to detect it with the blood screens. And autoimmune hepatitis is actually very manageable now days. Liver transplants are rarely required for AIH anymore. But we don't even know if you have AI problems so we'll have to wait and see.
Helpful - 0
Avatar universal
Thank you for your help and support. I will get new test results on Thursday (or Friday). I will share the upcoming results.
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Avatar universal
I got my blood results today. Autoantibodies are all negative.(AMA, ASMA and anti-LKM). But the radiologist found something in ultrasonography. The report is as following:
1)Parenchymal echogenicity is increased consistent with hepatic steatosis grade 1-2.
2)And a geographic contoured hypoechoic area with size 55×35mm is observed in the neighborhood of gallbladder. (Possibly fatty sparing)

(The original report is not in English. I tried to translate it to English. So it could be some mistranslations since I am not familiar with medical terminology.)

After seeing my doctor, he directed me to a gastroenterologist. And he said "if you were oldu, we would say you to go home. But you are too young so your results should be evaluated thoroughly by a specialist. And if necessary, the gastroenterologist might perform some further test."

I googled the USG result and I have non-alcoholic fatty liver disease. But I couldn't understand the second observation about gallbladder and why did my doctor said it's abnormal for you. I am so confused.
Helpful - 0
Avatar universal
It's wonderful that your doctor is being so vigilant in your following up. And adding a specialist is a great idea too. More eyes looking at the problem can only be more beneficial and through in helping out, especially by adding a GI specialist. The focus is being narrowed by the elimination of autoimmune problems and the diagnostic confirmation of liver steatosis.

Fatty liver grade-1 thru -2 are the earlier phases of the disease process. And fatty liver involves a minimum of 5 to 10% of the liver being comprised of fat (by weight or volume).  The more advanced fatty liver cases, grade-2 thru -3, has over 50% fat in the liver. The fat is stored within the hepatocytes as vacuoles, and this can interfere with the liver cell functioning.

Since the previous blood testing showed elevations that were primarily of the Alt enzyme, this starts to make sense. And given that it's your liver cells (hepatocytes) being stressed by the extra fatty vacuoles, this is what likely caused the cells to release the Alt enzymes.

Your doctor's comment about the abnormal "geographic contoured hypoechoic area" is likely based on a couple of things. First is the focal "contoured" shape. Our bodies respond to injuries and insults in a predictable way, and this usually leads to an well-defined scarring shape. Random processes can form crazy, haphazard scarring  formations. Also, there are a number of disease categories that can be involved within the gallbladder region: typical liver parenchymal diseases, gallbladder diseases and biliary diseases.

Since your liver numbers are only slightly elevated, hopefully you are only dealing with a minor, benign issue. And the recently confirmed fatty liver fits the profile. So let's hope it is only a fatty spared region that the ultrasound sees.
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