Lab Med Midterm pt 4

Question 1

67-yr-old man seen in consultation for coagulopathy during long hospital course associated with knee replacement; LFTs – Tbil, ALP, AST, and ALT normal; ALB 2.8 g/dL (little low); INR 2.8.

Diagnosis: ?

Answer 1

Vitamin K deficiency

INR of 2.8 is high for someone that is anticoagulated

Question 2

23-yr-old man noted by family to be jaundiced; uncle has history of similar episode; PE normal; LFTs normal except for bilirubin Tbil 4.5 mg/dL (ref. 0.3-1.0 mg), Dbil 0.3 mg (ref 0.0-0.2).
Diagnosis?

Answer 2

Gilbert’s syndrome – a benign, congenital condition of elevated bilirubin.

Question 3

Previously healthy 49-yr-old woman presents to emergency department with abdominal discomfort, nausea, vomiting, and confusion; on PE, noted to be icteric and agitated; LFTs- bilirubin 3.2 mg/dL; ALP 220 U/L, AST and ALT >6000 U/L; INR elevated.
Diagnosis?

Answer 3

ALT >1,000 U/L has limited differential diagnosis - acute viral hepatitis; drug toxicity (esp acetaminophen); shock liver; autoimmune hepatitis.

Question 4

Case: A routine battery of laboratory screening tests reveals an elevated AST level in a 40-year-old married male patient in whom signs and symptoms of liver disease are absent
What do you do next?

Answer 4

Repeat that test

Repeat testing is the first step whenever an asymptomatic patient has elevated liver enzyme levels on a screening test