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What Does This Blood Report Indicate?

Posted on Mon, 13 Jun 2016

Question: Hello - I am a 46 yr. old white female, non-drinker (drink zero alcohol ever, non-smoker). I had my gallbladder removed in 2013 and developed severe acid reflux for which I take 40mg/Nexium once/day. Recently I was having some abdominal pain and my PCP ordered blood work on 4/20/16--the results from that blood work are: T Bili - 2.0; Direct Bili - .6; Indirect Bili - 1.4; MPV - 12.4; all other CBC/Liver & Pancreas blood work is normal. I had elevated T Bili from 2005-2013 (up to 2.5 T Bilirubin at one point), but all other liver functions normal were always normal. After removal of gallbladder in XXXXXXX 2013, all liver functions normal. Now, abnormal liver results are seen from 4/20/16 blood work. Had non-enhanced abdomen CT scan in March 2016 with these results: multiple, small hepatic hypodensities (likely cysts) are again seen throughout the liver. My previous blood work was performed in XXXXXXX 2015 and all liver lab tests were normal. Question: given my latest lab test results from 4/20/16, is this cause for concern, meaning, could this be indication of liver disease? My PCP is sending me for abdominal U/S. Thank you.

Answered by Dr. Dr.P.Ratnakar Kini (2 hours later)

Brief Answer: XXXXXXX syndrome?

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.
Your total bilirubin is mildly raised. And also the indirect fraction is more than direct fraction.

All the liver enzymes are within normal limits. The hemoglobin is within normal limits.

Analyzing all these, it looks like you have a condition called XXXXXXX syndrome. It is a condition in which the uptake of bilirubin by the liver is affected.

This is a harmless condition and does not require any treatment

Let me know if you have any more questions.

Regards,
Dr.R.K.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr.P.Ratnakar Kini (50 minutes later)

Thank you. I was diagnosed with both NAFLD and Gilbert's disease years ago. The NAFLD left when I lost weight, but I seem to be 50 pounds overweight once again. I guess I'll found out tomorrow if I have NAFLD again as well. I was confused as to how Gilbert's disease seemed to have left for 3 yrs, after I had it for over a decade, but now it's back. Is that possible to have a period of a few years if normal liver tests and then the bilirubin becomes elevated once again for no reason...in association with Gilbert's disease? Or, is the bilirubin always elevated with this disease? Thanks

One more thing I forgot to add is my ALT is slightly elevated at 54, thus my concern there's an issue with the liver in conjunction with the elevated T Bili. Please let me know your thoughts. Thank
you.

Answered by Dr. Dr.P.Ratnakar Kini (10 hours later)

Brief Answer: XXXXXXX syndrome + NAFLD

Detailed Answer:
Hi,
Thanks for getting back to me with more questions.

In XXXXXXX syndrome, the liver enzymes always remain within normal limits.
But the bilirubin level may remain normal or keep fluctuating above the normal levels. But it never goes above 5.
Some of the causes of fluctuation (in the absence of any other liver related issues) are dehydration and fasting.
But you have an additional factor in the form of fatty liver which can raise bilirubin and liver enzymes. The ALT raise could be due to NAFLD. Since you have gained 50 pounds again, NAFLD is likely and an added factor in the abnormal liver panel.

Let me know if you have any more questions.
Regards,
Dr.R.K.

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Above answer was peer-reviewed by : Dr. Deepak