r*******n
发帖数: 51 | 1 年初体检，报告出来后family doctor打来电话，说有些指标异常，又做了一遍血检，
还是不正常。
数据如下
Ferritin: High 1127ug/L
Total iron binding capacity: Low 36umol/L
Alanine Aminotransferase: High 87U/L
Immunoglobulin G, Serum: High 17.7
ANA: Positive
Speckled pattern 1:160
Anti Smooth Muscle Abs: Negative
Hepatitis A, B and C: Negative
Lupus Anticoagulant: Normal
其他常规项目正常。Ultra sound显示a little bit fat liver.
怀疑hemochromatosis，转往hematologist,要求检查肝脏MRI，看是否含铁。
MRI结果：ferritin is unremarkable appearing liver.认为不是hematochromatosis
。建议转liver specialist.目前正在等待排期。
各位牛人能否帮看看，可能是什么原因？到底应该看哪个specialist？我自己觉得，要
是ANA为阳性，是不是代表应该看免疫的specialist呢？不过，hematologist比较
concern我的ALT高，认为应该转往肝脏specialist. | A*******s
发帖数: 9638 | 2 agree to see a hepatologist, need liver biopsy. | I****a
发帖数: 407 | 3 The key lab test is your normal transferrin 转铁蛋白. In general a normal
transferrin rules out most of the hemochromatosis type except 4A which is
also called ferroportin disease. It is very rare and I highly suspect you
have it.
I agree with A++, you should see a liver specialist. NASH which is also
called Steatohepatitis can cause elevation of ferritin. If you are a guy and
is over weight some, that is probably it. In this situation, high ferritin
is caused by low level inflammation from liver injury.
Disclaimer: I am not a hepatologist. | r*******n
发帖数: 51 | 4 Thanks for the suggestions and I do appreciate them!
A++: Is there any alternatives other than liver biopsy to confirm the
disease?
Icetea: My TIBC is actually low. I am a guy. My family doctor said my
weight is just below the upper bound of the normal range and need to control
weight from now on.
I talked to my family doctor and she said it would be possiblely related to
AIN or RA. But she would let liver specialist to do further investiagtion.
Are there any further tests to confirm that?
Many thanks! | A*******s
发帖数: 9638 | 5 You ferritin level is just too high and your LFTs is abnormal. Biopsy is the
only way if you want an answer.
Liver biopsy is a safe procedure, in my opinion.
control
to
【在 r*******n 的大作中提到】
: Thanks for the suggestions and I do appreciate them!
: A++: Is there any alternatives other than liver biopsy to confirm the
: disease?
: Icetea: My TIBC is actually low. I am a guy. My family doctor said my
: weight is just below the upper bound of the normal range and need to control
: weight from now on.
: I talked to my family doctor and she said it would be possiblely related to
: AIN or RA. But she would let liver specialist to do further investiagtion.
: Are there any further tests to confirm that?
: Many thanks!
| f*****w
发帖数: 1451 | 6 说两个小意见:
1.ana 如果是homogenous pattern,对于诊断lupus来说比较specific,speckled
pattern是最常见的,也是对不specific的,很多其他结绨组织疾病都可能会有阳性表现.
2.ferritin不仅代表体内铁,也是常见的感染蛋白,如果体内有炎症,不管是infection
or inflammation,都会出现ferritin增高.
3.楼主贫血吗?其他检查都正常?CBCD? | r*******n
发帖数: 51 | 7 Flonaw：家庭医生没说过我贫血，献血的时候说我的血红蛋白正常。
DIFFERENTIAL WBC'S:
NORMAL: Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils,
Immunoglobulin A Serum, Immunoglobulin M Serum, Ceruloplasmin, Alpha 1
Antitrypsin TL
ABNOMAL: Immunoglobulin G Serum (High, 17.7, normal range:7.2-16.9) | y******a
发帖数: 590 | 8 why did your family doctor check your ferritin level and ANA? what does she
suspect? or what symptoms do you have? | r*******n
发帖数: 51 | 9 My family doctor screens ferritin every a couple of years for males over 30s
. The ANA was ordered by the hematologist when she decided to transfer me to
a liver specialist. She just ordered a bunch of tests that she thought to
be helpful for the liver specialist. So when the liver specialist saw my
file, he could have certain clues of what was going on and then start from
there. Frankly speaking, I did not feel anything wrong, hmm...maybe
sometimes feel fatigue...sometimes mild pain on wrist and ankle in the
morning. However, I cannot tell whether it was because of activities the day
before or something else. | y******a
发帖数: 590 | 10 how about other inflammatory markers, e.g. CRP, ESR, albumin, platelet, LDH?
are they also elevated? | r*******n
发帖数: 51 | 11 I am not sure whether CRP, ESR and LDH were ordered or not. Below are all
tests that were ordered and normal.
Albumin and platelet are normal.
Besides, Creatinine, Creatinine(Crcl), Estimated Glomerular Filteration Rate
- MDRD, Bilirubin Total, Alkaline Phosphatase, and Gama Glutamyl
Transferase are normal.
Iron, Iron saturation, B12, TSH, A1C, eGFR, Cholesterol, Triglycerides, HDL,
LDL, TC/HDL-C Ratio, and Potassium are normal.
Hemoglobin, Hematocrit, RBC, RBC indeces: MCV, MCH, MCHC, RDW, WBC, and MPV
are normal.
Protein Electrophoresis:
Protein - Total, Alpha 1 Glubulin, Alpha 2 Glubulin, BETA Glubulin, and
Gamma Glubulin are normal.
Anti Smooth Muscle Abs: Negative
Hepatitis A,B and C: Negative
Lupus Anticoagulant:
Activated Partial Thromboplastin Time, and Russell Viper Venom are Negative.
Yuzaiusa: Do you think I should check CPR, ESR and LDH? What is the theory behind? | y******a
发帖数: 590 | 12 No I don't think you need to check those. As fionaww mentioned earlier,
ferritin is also a marker for chronic inflammation. But with chronic
inflammation, you will see other abnormalities, like anemia, low albumin, high
platelet count, high ESR, CRP, and LDH. With a normal albumin and PLT, it's
unlikely you have chronic inflammation going on. | A*******s
发帖数: 9638 | 13 I think the real question is:
which one is more sensitive for hemochromatosis: serum ferritin level or MRI
of liver?
Any GI guy can answer the question? | y******a
发帖数: 590 | 14 I am not a GI.
serum ferritin is nonspecific, has low positive predictive values for HH. serum tranferrin saturation is more specific. |
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