significance of sgpt (alt) and creatnine in thalassemia intermedia

This is alyshah LFT report


S. Total Bilirubin 1.5
S. Direct Bilirubin 0.3
S. Indirect Bilirubin 1.2
Gamma GT 12
Sgpt (alt).  97
Alkaline phosphatase 233

Her doctor has stopped HU for a week.

Andy how can I help bring down her sgpt.  And how did her sgpt decreased from 129 to 97 in just 36 hrs. Also should I keep giving her folic acid and her other vitamins .

http://www.clinlabnavigator.com/alkaline-phosphatase-alp.html

Several caveats must be remembered in interpreting ALP results:

ALP levels should always be measured after fasting because enzyme levels increase as much as 30 U/L after food ingestion. Patients with blood group O and B who are secretors can have increased ALP levels after eating a fatty meal because of the release of intestinal enzyme.
African Americans have 10 to 15% higher ALP serum levels than Caucasians.
In children, ALP is increased up to 3 times the upper limit of normal and in pregnant patients it can be increased up to 2 times normal.

These values vary greatly with time of day and after ingesting fatty foods.

The response should be to cease the drug until levels return to normal and then the drug should be started again. I will mention again that hydration is extremely important and should never be overlooked.

Thanks Andy for your informative replies. They really help people in our situation to calm. Don't know what I would have done without the support of this forum.

Hi Andy
Hope you are doing well. I was just wondering could a diet high in fat increase the sgpt (alt) ? We have started HU again. Hopefully this time we won't have any issues. I am trying to keep her very well hydrated. But I was wondering could a diet high in butter increase the sgpt (alt). For the moment I have really cut down on fatty food from her diet. Can you plz advise on this.
Thanks
Asma

It might have an effect on absorption of the drug by the liver. Try low fat and see if it makes a difference. Let us know the results.

Hi Andy
As you might remember alyshah sgpt was very high at 97 at her last tests about 3 week. So her doctor had stopped HU for a week. Then I started giving her HU with a very low fat diet. Now here are her results

Hb 7.0 increased from 6.7
Sgpt(alt) 20 decreased from 97
Creatnine 0.2

So Andy I think that low fat diet definitely makes a difference. I would recommend it to everyone !!!

Also I have a question. Alyshah is sneezing quite a lot and has a buy of chest congestion. She doesn't have fever. So I am just giving her anti allergic and have not stopped hydrea. Do u think its likely that her hb might drop due to illness but having no fever. And what makes the drop in hb? The illness itself or the fever or the antibiotic we use to treat the illness ?

Thanks for your advice
Asma

I don't think her Hb will drop due to allergies. Sickness can cause an Hb drop, as the body's resources are depleted by illness.

Thank you for your report. More and more we are seeing that high fat foods cause problems for people using drugs like Hydroxyurea and Exjade.

Hi Andy

How are you doing. I got alyshah tested for her monthly hb test and Creatinine and LFT. Her hb has increased to 7.5 . All other tests are well within the range. The only issue is that her platelets count is very high at 11000 when the normal range is 150-450 . Why do u think this happened. What are we supposed to do now. Her doctor appointment is for 11 Nov. I am very worried. Her weight is 14.5-15kg. And she is taking 4ml hydroxyurea. Plz advise what can I do while waiting for the doctor appointment. I am extremely worried.
By the way she had severe urine infection three weeks back for which she took antibiotics. Can that effect it ?
Thanks
Asma

Hi Asma,

Yes, an infection could have caused the rise in platelets. I would also suggest re-testing because platelets tests are often wrong in thals, as the small red cells are often counted as platelets. Has she started taking vitamin E yet?

Yes she is taking vitamin E. Should I be worried about high platlets and should I keep giving HU or stop it.

Whenever high platelets are reported, I think re-testing is needed before making any changes. The platelet test is the test that is most commonly read wrong in thals. Don't change anything until you have talked to your doctor. Ask for another platelet test.

How are you doing. Alyshah hb has increases to 8.5 but there is something new in comments. Although everything is well within range.
Hb 8.5
Wbc 12.3 normal range (5-15)
Neutrophils 32.2 normal range ( 25-35)
Lymphocytes 61.3 normal range (45-65)
Eosinophils 0.7 normal range (1-6)
Monocytes 5.6 normal range (5-9)
Basophils 0.2 normal range (0-1)
Platelets 172 normal range (150-400)

The thing is that this time in comments section this is mentioned for the first time in her reports

Occasional myelocytes and metamyelocytes seen leucoerythroblastic picture clinical correlation is advises.

now what does this mean. she is on HU 3.5ml . Andy plz explain this to me and help. Do i really need to go see her doctor.

asma

Myelocytes are immature white cells. I believe this is monitored to make sure nothing unusual occurs while using hydroxyurea. Ask your doctor about the level next time. I don't think there is any reason at all for alarm.