ALT / ALAT issues

Dear friends,
My 9 year old is using Jadenu (Exjade until March this year). Yesterday her hem discovered her ALT/ALAT (in our country its ALAT) is elevated and is 300.
We had this issue in January as well (600), but at that time we could relate it to flu and high fever. This time she has now signs of health issues, and we are worried. We stopped Jadenu yesterday and will go back for new blood samples in two days.

Any experience with this? Suggestions?
Should we be worried?

Try splitting the dose into two and taking it in morning and evening. Make sure the child stays well hydrated, as this does affect the liver values. Have the test done early in the day for a more accurate reading, as activity raises these levels. Consider giving the child milk thistle herb, as this will help, as well, while also giving thee liver some protection.

Thank you Andy! We are splitting the dose and giving with meals morning and evening. We are giving it together with breakfast and dinner which is not always light - do you think that matters?
Her activity level is quite high - she is playing handball, walking to school and have other activities. She can do that as she usually pre hb around 10.
But do you think the activites affects the ALT and can be the reason?

We will watch the hydration closer, give tee and herbs.

Activity raises the ALT's. With someone so active, it's best to schedule tests early in the morning. Also, with activity comes an increased demand for hydration. Make sure she is well hydrated before tests. Good hydration can also make the Hb look lower, even though it isn't, so don't be concerned if you see a small drop in Hb.

Thank you Andy!
New test this morning after a weekend with low activity. Levels increased from Friday (Enzymes). AST is 95, ALT os 555 (from 343) and Gamma 29 (don't know how to translate). We are going back for ultrasound of stomach tomorrow morning. In the meantime I am trying to keep calm....

Was there ever any issue when she used Exjade?

Yes, we had the same issue in January when she still was on Exjade. But then we related it to her flu with high fever. The ALT, AST and Bilirubin was still high Tuesday (ALT 482, AST 140, Bilirubin 39). We are hoping it is lower tomorrow. A LOT of blood  test has been done without giving answers and the ultrasound showed nothing with liver or gallbladder.

How low is her ferritin?