What Causes Elevated AST Levels And Iron Saturation In A Young Adult?

Posted on Mon, 4 Jul 2016

Question: For the last 3 year +/- my son has had just above high SGPT (ALT)liver enzyme tests and sometimes an elevated SGOT (AST). The SGOT has recently shown high but within normal ranges. He also shows normal ferritin BUT a high Calculated Iron Sat flux between 67-70% when high. He does not have the markers for the heredity Hemochromatosis PRC (negative for C282Y, negative for H63D, and negative for (S65C). Abdominal ultra sound all came back normal. CBC bloodwork all great, thyroid great, no hepatitis A, B or C. Thoughts?

Answered by Dr. Tayyab Malik (5 hours later)

Brief Answer:
Resolved hepatitis with unknown cause

Detailed Answer:
Thank you for posting query.

Noted that your son was diagnosed with acute hepatitis which is resolved now. However no cause was established. All major causes have been ruled out.

I would also like to know if autoimmune hepatitis, ESR and Fatty Liver Disease were ruled out?
secondly, was a liver biopsy done?

Last, but not the least, if liver function test are normal and no symptoms are present, then there is nothing to worry.

Hope to answer your concern. Any further questions are welcomed and/or your feedback review would help me improve the quality of my answers.
thank you.
wish him good health.
any further queries are welcomed.

Regards,
Dr Tayyab Malik

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Tayyab Malik (59 minutes later)

He was NOT diagnosed with Hepatitis. I said NO hepatisis A, B, or C and LIVER FUNCTION TESTS are showing elevated SGOT (AST) and elevated IRON Saturation but Ferritin and other liver tests other than SGOT are fine. I am wondering what is the next step in diagnosing.

Answered by Dr. Tayyab Malik (13 minutes later)

Brief Answer:
Elevated AST and Iron Saturation: No HBV,HCV and NO hemochromatosis

Detailed Answer:
Thank you for getting back to me.
yes, i noted that AST is elevated as mentioned in your previous query.

Abnormal Elevation in any of liver enzymes is termed "hepatitis"(upto 42 IU/L is considered normal). Viral infection (Hep A, B or C) are one of the cause of hepatitis and there are other causes.

secondly , I requested in my last answer that did your son test for
1. autoimmune hepatitis, and Fatty liver disease?
2. did he test for "Erythrocyte Sedimentation Rate"(ESR) which reflects any chronic inflammation in the body? any chronic inflammation in the body may also lead to Elevated iron saturation.
3. is your son overweight or obese?
4. was a liver biopsy done?
5. was any medication being used before AST and iron saturation were tested?

if answer to aforementioned questions is NO,
, next step would be to test :
1. Lipid Profile
2. autoantibodies
3. ESR
and maybe Liver biopsy depending on the results of the tests.

Hope to answer your concern. Any further questions are welcomed and/or your feedback review would help me improve the quality of my answers.
thank you.
wish him good health.
any further queries are welcomed.

Regards,
Dr Tayyab Malik

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Tayyab Malik (4 hours later)

I am not sure if he had the autoimmune hepatitis test but the ultrasound showed no fatty liver disease and all the other liver tests he has done does not show that. We are going to do the ESR test. He is not overweight in fact he eats a LOT of calories each day (probably double any of his friends) and does not gain weight. We have not had a liver biopsy. There was no medication before the AST test.
I am wondering if in your professional opinion everything comes back normal (as all the other tests have) what should we do about the high iron saturation because the ferritin remains very normal and the high AST? Thank you,

Answered by Dr. Tayyab Malik (1 hour later)

Brief Answer:
Asymptomatic patient with high AST and high Iron saturation

Detailed Answer:
Thank you once again for getting back to me.

putting together, i observe that, your son is healthy except the HIGH AST and high transferrin saturation levels. He has NO symptoms. therefore, No need to worry.

cause maybe idiopathic if ESR also comes out to be normal.
therefore, Conservative treatment/OBSERVATION is advised until transferrin saturation level comes normal. Iron usually deposits in liver, pancreas, heart and joints so :

as said "prevention better than Cure". He does not be cured now as he is ASYMPTOMATIC. Iron-Free or Low Iron Diet is vital. Discuss with treating doctor.
advice to: ( blood test/ECG every 4 to 6 months)
1. Monitor his Liver function test (to prevent hepatitis)
2. Monitor his blood glucose level (to prevent diabetes)
3. ECG (to prevent cardiomyopathy)
4. Complete blood cell test ( "if low hemoglobin", rule out all causes of anemia)
5. AVOID foods rich in iron - mutton, liver, tuna, strawberries, dried beans, dried peas, apricot, peaches.
6. hope that transferrin saturation values come down following iron-low diet .
if not, then discuss using iron chelator (deferrasirox) with your treating hepatologist

Hope to answer your concern. Any further questions are welcomed and/or your feedback review would help me improve the quality of my answers.
thank you.
wish him good health.
any further queries are welcomed.

Regards,
Dr Tayyab Malik

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Tayyab Malik (2 hours later)

Thank you Dr. Malik! I have asked his doctor for some of the additional tests that you recommended and we will see how it all goes. Thank you again.

Answered by Dr. Tayyab Malik (10 minutes later)

Brief Answer:
Observation, Monitoring and further evaluation advised

Detailed Answer:
Pleasure to be of any help.

kindly close this dialogue box and rate the answer.
Hope to answer your concern and your feedback review would help me improve the quality of my answers.
thank you.
wish your son good and sound health.
any further queries are welcomed.

Regards,
Dr Tayyab Malik

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Above answer was peer-reviewed by : Dr. Naveen Kumar