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Medical Forum / General / General / March 2004blood tests question (bilirubin and iron)
Hi. I received results from some blood testing today. There were a few things which were out of range. I have no history of elevated levels of these three things, and I'm not on medications and have no history of disease and do not drink alcohol, etc. This was just testing done along with my annual physical. I did fast for about fourteen hours before the test. I'm male, 24. bilirubin 2.1 MG/DL (reference range: 0.2 - 1.3) iron 231 mcg/dl (reference range: 35 - 185 ) phosphorus 2.4 mg/dl (reference range: 2.5 - 4.5 ) I just wanted to ask opinions on this since my appointment with a doctor isn't for another ten days, and I'm a little worried about it. BTW, I'm wondering if my habit of eating lots of carrots and tomatoes(lycopene) can cause a false high on the bilirubin. I searched and did not see anything that suggested that it could, but I thought I'd ask. Thanks. > Hi. > [quoted text clipped - 18 lines] > > Thanks. I would be obviously interested in other liver function tests such as ALT or AST. Follow-up testing is in order. If other liver function tests ,such as indirect bilirubin and the two mentioned are normal, then it may be simply a case of Gilbert's syndrome where a person has a minor problem dealing with bilirubin especially in the prolonged fasting state. The other thing one would look for in an elevated iron is genetic hemochromatosis which may also cause liver damage. Is there any family history of hemochromatosis? The two conditions above are genetically inherited so you might want to ask family about that. The next step is to verify the previous abnormals with repeat and more tests to better define the nature of the abnormality. The liver is a major organ so just about anything can cause changes. The list of possibilities are pretty endless but given the fact that you are young and do not have overt disease right now is a point in your favor. Go od luck Robert "> I would be obviously interested in other liver function tests such as ALT or > AST. Follow-up testing is in order. If other liver function tests ,such as > indirect bilirubin and the two mentioned are normal, then it may be simply a [quoted text clipped - 12 lines] > od luck > Robert Hey there. I have hemochromatosis, can can possibly give some insight there (take it for what it is... not medical advice). Ferritin level is what seems to be the best indicator. The range max is somewhere in the 400's. The hemochromatosis was discovered last June, and at that time, my ferritin was 5,100. Since then, I've had pretty agressive blood-letting. I get a blood test every Wednesday, and give 1 to 1 1/2 pints every Thursday. Since June, the ferritin has dropped to just under 1,000. As was said, too much iron can severely damage organs. The ALT, AST and Alkaline Phosphatase are the three liver function tests done weekly, as they indicate an irritated liver. They can very drastically. The most important thing to look at (I believe) is whether it improves over time... indicating no final damage has been done. The liver can really fix itself up given the chance. I had several indicators for years, and the doctors I saw in the past didn't put the pieces together. I thank God for the doctor I have now, who discovered the hemochromatosis. So here's the indicators that can be attributed to my condition: 1) Arthritic pain in my ankles and shoulders for the past 9 years... starting when I was just 30 years old. By the way, this has improved dramatically in the last 9 months. 2) Migranes - I believe they are caused by food alergies. This could have possibly been brought about by my liver not functioning correctly. I watch what I eat now, but have had very few migranes in the past 4 or 5 months. I used to get 2 or 3 a week. 3) I was tired a lot, even though I was going to the gym frequently. These symptoms may not appear for quite sometime. As the iron builds up over the years, symptoms can start to pop up. As far as what I can and can't eat, it's not as dramatic as you may think. Food with some iron is ok. What I need to stay away from is food that has huge amounts of iron, and things that cause the body to retain iron. Basically, I stay away from Vitamin C, iron skillets, spinach, etc. But I can eat meat, just as long as it's not excessive. Ok. I hope this helps a little. Sorry for the book. John > "> I would be obviously interested in other liver function tests such > as ALT or [quoted text clipped - 56 lines] > > John That was my impression also John in that most symptoms take years to develop and quite often it is only suspected in the fourth decade and not really in the one's twenty's. There are genetic testing available for it now that every family member should have if a family history is positive. You may want to cool it on the carrots and lycopene until you talk to your doc. Check out this URL: http://nutritionfocus.com/nutrition_supplementation/vitamins/beta-carotene.html "SIGNS OF TOXICITY 50,000 IU's (provitamin A) daily may be toxic, 18,500 IU's (provitamin A) daily for 1-3 months toxic for infants, 25,000 IU's (provitamin A) can produce liver damage, large doses lead to anemia and gout, anemia, blurred vision, bone pain, diarrhea, fatigue, gout, hair loss, headaches, irregular periods, liver enlargement, nausea, vomiting. Prolonged excessive intake results in abnormalities in skin, eyes, and mucous membranes, blurred vision, bone fragility, deep bone pain, enlargement of liver and spleen, reduced thyroid activity, skin rashes, thickening of long bones. If toxicity is detected, the symptoms will disappear in a few days after the vitamin is withdrawn. (An International Unit (IU) of Vitamin A is equivalent to 0.6 mcg of beta-Carotene) " Did your blood testing include liver enzymes? Vitamin A is a fat soluble vitamin - not easily gotten rid of if excessive amounts are ingested. Bilirubin goes up if there's liver problems. Bilirubin is broken down into indirect and direct bilirubin. The two will add up to the total bilirubin (which is the 2.1 you've indicated). Your lab will probably only report out the total unless both are asked for. Direct bilirubin elevation is indicative of a liver problem, but a much more sensitive indicator is GGTP and/or SGPT (liver enzyme testing). Are you taking big doses of Vit. A along with all the carrots and lycopene? Be sure you don't go overboard with the Vit. A. Be sure to tell your doc exactly how MANY carrots you're eating. He may want to do a carotene level to make sure you're okay. http://www.emedicine.com/derm/topic789.htm This is also interesting. Again, give your doc a REAL GOOD history and that will help him immensely. Judy Dilworth, M.T. (ASCP) Microbiology (but used to do chemistry) > bilirubin 2.1 MG/DL (reference range: 0.2 - 1.3) > iron 231 mcg/dl (reference range: 35 - 185 ) > phosphorus 2.4 mg/dl (reference range: 2.5 - 4.5 ) > BTW, I'm wondering if my habit of eating lots of carrots and > tomatoes(lycopene) can cause a false high on the bilirubin. I > searched and did not see anything that suggested that it could, but I > thought I'd ask. > You may want to cool it on the carrots and lycopene until you talk to > your doc. Check out this URL: http://nutritionfocus.com/nutrition_supplementation/vitamins/beta-carotene.html > "SIGNS OF TOXICITY > 50,000 IU's (provitamin A) daily may be toxic, 18,500 IU's (provitamin [quoted text clipped - 9 lines] > International Unit (IU) of Vitamin A is equivalent to 0.6 mcg of > beta-Carotene) " Those are all good points Judy. I think a distinction should be made between eating carrots and taking Vit A. Most people who eat a lot of veggies can end up with yellow skin but will have normal liver function including bili and a beta carotene can help with that as you stated. The other point concerning this is that a multi-chemistry panel probably included one transaminase level that this person did not comment on but if a phosphorus was included in the panel I am sure that one was. Trying to read tea leaves here but, iron levels and PO4 is not typical for the standard biochemical panel. Any iron would have to be specifically added on in the US that is because of raising health care cost. Only clinically relevant testing is allowed on a case by case basis. We can not even order a T7 anymore as they have to order a T3uptake and a T4 separately. Follow up testing is appropriate and that is why multi-chemical profiles are getting banned. The more tests included in a battery the higher the chances that you will get an abnormality that is not clinically relevant but adds costs by follow-up expenses. If twenty tests are run, through chance alone one of those can be abnormal. Out of statistical reference range is a better term than abnormal. Most of these pickups occur in the clinically asymtomatic and thus the push for clinically relevant testing. There is something wrong when an iron and phos is done on a 25 year old male asymptomatic male. I am in my fifth decade and have never had an iron ordered on me. There is no guidelines as yet on having doing so. Good point about the iron. I was kind of wondering about that. Iron levels aren't usually ordered unless something in the CBC would indicate that it would be needed, correct? Also, I was wondering about the bilirubin testing in absence of enzyme testing. Usually at least ONE liver enzyme is thrown in (as I recall in the olden days of panel testing, it was usually an SGPT, but maybe not nowadays. Actually, that may have only been thrown in if a liver battery was ordered). Thanks for clearing up the Vit. A vs. carrots thing. CE is always a good thing for we techs who have migrated into different areas over the years. Judy Dilworth, M.T. (ASCP) Microbiology (but remembers some chemistry :-)) > Those are all good points Judy. I think a distinction should be made > between eating carrots and taking Vit A. ..... Trying to read > tea leaves here but, iron levels and PO4 is not typical for the standard > biochemical panel. Any iron would have to be specifically added on in the US > that is because of raising health care cost..... There is something wrong when an iron and phos is done on a 25 year old male asymptomatic male. I am in my fifth decade and have never had an iron ordered on me. There is no guidelines as yet on having doing so. > Good point about the iron. I was kind of wondering about that. Iron > levels aren't usually ordered unless something in the CBC would indicate > that it would be needed, correct? There was a lab offering an outragous panel in order to make money. The feds went after them and put the national lab chain owner in jail for of all things iron. > Also, I was wondering about the bilirubin testing in absence of enzyme > testing. Usually at least ONE liver enzyme is thrown in (as I recall in > the olden days of panel testing, it was usually an SGPT, but maybe not > nowadays. Actually, that may have only been thrown in if a liver battery > was ordered). The expanded chemistry panel survived and you are right, it may includes the SGPT. It does not include thyroid, iron, and cholesterol. The bili with SGPT has always been there and I am pretty sure that if the bili was done it was also done. > Thanks for clearing up the Vit. A vs. carrots thing. CE is always a good > thing for we techs who have migrated into different areas over the > years. > > Judy Dilworth, M.T. (ASCP) > Microbiology (but remembers some chemistry :-)) I appreciate your point of view, it is always uses a fresh look at some things I miss like the vit A connection. >> Good point about the iron. I was kind of wondering about that. Iron >> levels aren't usually ordered unless something in the CBC would indicate [quoted text clipped - 3 lines] >went after them and put the national lab chain owner in jail for of all >things iron. Although, Robert, in your initial excellent response, you did acknowledge the possibility of hemochromatosis. While routine screening is still controversial and not currently recommended by general consensus, perhaps this one doctor does feel screening is valuable and routinely orders iron panels in his relatively young patients. PF > >> Good point about the iron. I was kind of wondering about that. Iron > >> levels aren't usually ordered unless something in the CBC would indicate [quoted text clipped - 12 lines] > > PF Maybe, but with present genetic testing it is not a good idea to rely simply on iron studies in early cases where alterations in iron handling is a common nonspecific finding. Keep in mind simple hemolysis can increase the iron level. If a family member has the condition then a normal iron is not assurance of anything in another young related patient. My impression, which might to wrong because we don't know enough about the situation, is that the iron was being used as a part of a general screen. The insurance carrier will eat the cost if it was the one asking for it or it can deny the claim based on symptom complex code billing. The doctor can order any test he wants to but must answer to the all mighty dollar. I think iron studies should be done at least once in all males but at what age is the question and do genetic studies in those with high risk at an early age as possible. None of these appear worrisome. Reference ranges are based on statistical averages; there will always be outliers at both ends of the scale. If your other liver enzymes and blood count are normal, I would not be concerned about the slightly elevated bilirubin level. There are some benign disease states, such as Gilbert's syndrome, which manifest as chronically elevated bilirubin levels without any other symptoms. This is usually familial. As for the slightly elevated iron, if your ferritin level is normal, I wouldn't be concerned about that either. If your ferritin was also elevated, one might consider a diagnosis of hereditary hemochromatosis. > I received results from some blood testing today. There were a few > things which were out of range. I have no history of elevated levels [quoted text clipped - 6 lines] > iron 231 mcg/dl (reference range: 35 - 185 ) > phosphorus 2.4 mg/dl (reference range: 2.5 - 4.5 ) |
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