Occasionally, a patient may have features of both autoimmune chronic hepatitis and PBC known as AIH/PBC overlap syndrome. Copper is present in the serum in two forms: copper that is bound to ceruloplasmin, and free copper or the non-ceruloplasmin bound copper. Lazaridis KN, Juran BD, Boe GM, et al. MedlinePlus. Dark-colored urine and/or light-colored stool. More recently, the results of a 2021 meta-analysis of 19 observational studies involving 222,067 people also suggested that coffee consumption was associated with lower ALT. See the Disease Management chapter on Hepatitis C for further details. . Therefore, the finding of autoantibodies in low titer is not sufficient evidence with which to make a diagnosis of autoimmune chronic hepatitis or PBC. If other liver tests such as bilirubin, aspartate aminotransferase (AST), or alanine aminotransferase (ALT) are also high, usually the increased ALP is caused by liver damage or disease. Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes, into the bloodstream, elevating liver enzymes on blood tests. Your liver enzymes can go up and down 40-100 points a day. This serves two purposes, determining fibrosis and providing an assessment of iron stores. IL28 has two isoforms, namely IL28A and IL28B. But in the meantime, there are a few things you can try that may help lower your ALT levels. To help lower ALT levels, consider adding more folate-rich foods to your diet, such as: leafy greens, including kale and spinach asparagus legumes Brussels sprouts beets bananas papaya You can. Bacon BR, Adams PC, Kowdley KV, Powell LW, Tavill AS; American Association for the Study of Liver Diseases. The liver enzymes are used to represent active liver damage, it isnt all that related to the actual function of the liver. Those with TT have the least response to treatment. Pregnancy- The placenta,at the beginning of the third trimester,produces high levels of alkaline phosphatase enzymes. The most commonly used anti-HCV antibody test is an enzyme immunoassay with a specificity of greater than 99%. But if your levels are lesser or greater than the . For women younger than 45 years, a GGT level greater than 27 units per litre is considered high. Our Alkaline phosphatase expert will provide you with the most accurate interpretation of your blood test results and treatment within 12 hours. By contrast, alanine aminotransferase (ALT) is found mainly in the liver. Advertising revenue supports our not-for-profit mission. The law states that we can store cookies on your device if they are strictly necessary for the operation of this site. HCV, hepatitis C virus; EIA, enzyme immunoassay; PCR, polymerase chain reaction. Wilson disease is rare. Alkaline phosphatase (ALP) is an enzyme present in all human tissues throughout the body. The extent of clinical manifestation from reactivation HBV can vary from a transient, clinically silent disease to severe or acute liver failure. A ratio greater than 3 is strongly indicative of alcoholic hepatitis. 2017;5(4):394-403. doi:10.14218/JCTH.2017.00027. Coffee consumption and the liver the potential health benefits. Thus the sole viral marker may be anti-HBc. This may be due to physical liver injury or chemical, infectious, toxic or autoimmune damage to liver cells. According to Google: AST elevation generally indicates liver damage if ALT, bilirubin, and ALP are also elevated. This is where fat infiltrates your liver and harms it. Viral hepatitis most often produces a hepatocellular pattern of injury (AST and ALT level elevations predominate). Very high AST levels (1000 units/L) are most commonly due to viral hepatitis, ischemic hepatitis or liver injury due to drug or toxin. A chronic infectious state can also be seen following HBV reactivation. The latter has evidence of hepatocellular injury in addition to fat accumulation. All coffee types decrease the risk of adverse clinical outcomes in chronic liver disease: A UK Biobank study. You neither mentioned past medical history. Like ALT, AST is normally present in blood at low levels. If the results are greater than 120 U/L for Alkaline phosphatase and more than 37 U/L for AST SGOT, you may also need some follow-up tests that will help detect the underlying disease early. Younger and younger people are presenting with abnormal liver enzymes and this threatens to be a potential public health crisis. Genotyping continues to gain importance for treatment determinations. Alkaline phosphatase (ALP) is an enzyme found in several tissues throughout the body. Adopting a healthier diet can help lower ALT levels and reduce your risk of liver disease. High levels of Alkaline phosphatase and AST SGOT in the blood indicate a variety of health problems. It has a high sensitivity and a very high specificity. The GGTP level is too sensitive, frequently elevated when no liver disease is apparent. Please see the chapter on Non-Alcoholic Fatty Liver Disease in Disease Management. To improve liver health and help lower ALT, you dont necessarily need to make drastic changes to your diet. The normal range of an SGOT test is generally between 8 and 45 units per liter of serum. Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis. In Wilson disease, copper also accumulates in the basal ganglia of the brain, where it produces a wide gamut of neurologic abnormalities. Hepatic alkaline phosphatase is most densely represented near the canalicular membrane of the hepatocyte. hearts of the farmers were flooded with joy as their crops were rescued. ; ; ; what does high alt ast and alkaline phosphatase levels This is the dose involved in many studies looking at the link between folic acid and ALT levels. health information, we will treat all of that information as protected health In time, HBeAg may be lost, replaced by its antibody, anti-HBe. The hearts of the farmers were flooded with joy as their crops were rescued. Depending on which value is elevated and the amount of elevation, doctors can often get a pretty strong indication as to what disease is involved. ALP changes can be interpreted within the context of other parameters while monitoring disease activity to better understand the underlying pathology. The ratio of AST/ALT is of little benefit in sorting out the cause of liver injury except in acute alcoholic hepatitis, in which the ratio is usually greater than 2. This measurement can point to liver diseases, but only if the enzyme levels are elevated several times above normal. American Gastroenterological Association. liver damage if ALT, bilirubin, and ALP are also elevated. When theyre present, early signs and symptoms can include pain in the area, Your liver is an essential organ that serves many purposes in your body. It is sometimes useful to determine the fraction of total serum bilirubin that is unconjugated versus that which is conjugated, usually referred to as fractionation of bilirubin. . These concepts are more fully developed elsewhere in the Cleveland Clinic Disease Management. Patients may present with liver disease, brain disease, or both. All rights reserved. This site complies with the HONcode standard for trustworthy health information: verify here. An important corollary is that an AST greater than 500 IU/L or an ALT greater than 200 IU/L is not likely to be explained by acute alcoholic hepatitiseven in an alcoholic patientand should suggest another etiology.6. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study [published online ahead of print March 17, 2004]. After 8 weeks, those in the diet group had lower liver enzymes and a greater reduction in liver fat. Anti-HAV IgG antibodies are also seen following vaccination. AST is found in the liver, brain, pancreas, heart, kidneys, lungs, and skeletal muscles. However AMA has been shown to be present in increased frequency in relatives of patients with PBC. Some examples of conditions that increase or decrease Alkaline phosphatase levels include: If you want your blood test report to be interpreted by Alkaline phosphatase specialist, you can upload your report. ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Drink plenty of water before your appointment. Upload blood test report now, Alkaline phosphatase treatment - Click to read 10 GOLDEN ARTICLES on Liver health. These are your blood streams serum level of liver enzymes the indicate it is NOT doing well. This syndrome is easily diagnosed when all standard liver-test results are normal and 90% or more of the total bilirubin is unconjugated. It will also cover what happens during testing and what test results can reveal. Consult a doctor for your Alkaline phosphatase problem. Studies have also shown that the serum levels of P3NP reflect the degree of fibrosis in chronic liver disease. Diagnosis and treatment of Wilson disease: an update. This is because the standard screening tests performed by most laboratories measure the level of total anti-HAV antibodies. (2019). Jaundice (a yellowish color of your skin and eye whites. The AST, ALT, and alkaline phosphatase tests are most useful to make the distinction between hepatocellular and cholestatic disease. Liver biopsy is indicated if competing etiologies cannot be ruled out, if a co-existing liver disease is suspected, and for patients at risk of developing cirrhosis.17. Malakouti M, et al. the unsubscribe link in the e-mail. Serum alkaline phosphatase comprises a heterogeneous group of enzymes. Swap fried foods for baked or roasted ones. This site uses different types of cookies. The abnormalities are called C282Y and H63D mutations respectively. If your AST levels are too high, it might be a sign of an injury affecting tissues other than the liver. One such study conducted in the U.S. identified an ALT upper limit of 29 IU/L for men and 22 IU/L for women.5 In asymptomatic patients with minimal elevations of aminotransferases, it is reasonable to repeat the test in a few weeks to confirm elevation. Ultrasound or other imaging techniques are necessary in all patients to exclude bile duct obstruction as the cause of cholestasis. They are the CC, CT, and TT genotypes. Pre-menopausal women with C282Y homozygosity most often have no iron accumulation. Elevated levels of ALP in the blood are most commonly caused by liver disease, bile duct obstruction, gallbladder disease, or bone disorders. You will be asked to make a fist to help make the vein easier to find. If we combine this information with your protected The AST level is higher than the ALT level, and the ratio is greater than 2:1 in 70% of patients. High Alkaline phosphatase and ALT SGPT levels in the blood can cause a number of health problems. - Very high AST levels (1000 units/L) are most commonly due to viral hepatitis, ischemic hepatitis or liver injury due to drug or toxin. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. What Are the Warning Signs of Alcohol-Related Liver Damage? Yes raised Alt may signify liver disease but its the ratio of Ast/Alt is a more significant marker for any liver disease. Is the European Tour as good as the PGA Tour? Zhang S, et al. We'll assume you're ok with this, but you can opt-out if you wish. Higher frequency of bone fractures. Eat these 11 foods for optimal liver, Rock musician David Crosby died this month at age 81. What Is a Comprehensive Metabolic Panel (CMP)? The common denominator is the modern diet. However, the test is currently not readily available in commercial laboratories and has not yet been validated for use. NAFLD is the most common cause of mildly elevated liver enzymes. Upload blood test report now, Alkaline phosphatase treatment - Click to read 10 GOLDEN ARTICLES on Liver health. ALT is found mainly in the liver. Acute alcoholic hepatitis may be mild or life threatening. Some common causes of elevated alkaline phosphatase (ALP) include: Liver disease (hepatitis, gallstones, cirrhosis, liver cancer), Bone disease (Pagets disease, bone cancer), Obesity (why this happens is still unknown and is being researched), Tumors (Hodgkins lymphoma, lung cancer, ovarian cancer, prostate cancer, testicular cancer), Pregnancy (not a cause for concern as this is normal in the third trimester, absent other health problems), Chronic kidney disease (also with diabetes, hypertension, and cardiovascular disease, which all affect the kidneys), Certain medications (birth control, steroids, other hormonal medications, anti-inflammatories, narcotics, antidepressants, anti-epileptics, anticonvulsants). Elevated (too high) levels of liver enzymes are a warning sign that something might be harming the liver. Liver imaging by ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) most often identify infiltration of the liver by mass lesions such as tumors. Cinacalcet, a drug for chronic kidney disease, can reduce blood alkaline phosphatase levels by more than twenty percent in patients after 26 weeks of administration. Since most patients with metastatic castration-resistant prostate cancer (mCRPC) have bone metastases, it is important to understand the potential impact of therapies on prognostic biomarkers, such as ALP. ALT blood test. Friedman LS. Transferrin saturation less than 45%, in addition to normal serum ferritin level usually rules out iron overload (negative predictive value of 97%), and no further testing is necessary. To make matters more confusing, the conjugated bilirubin is sometimes referred to as the direct-reacting bilirubin and the unconjugated as the indirect-reacting bilirubin (Table 3). ALT, alanine aminotransaminase; AST, aspartate transaminase; LDH, lactate dehydrogenase. Elevated liver enzymes are a product of inflamed or damaged liver cells leaking more than the usual amounts of certain chemicals, including liver enzymes into the bloodstream. Elevated liver enzymes in asymptomatic patients - What should I do? On the other hand, if liver disease is slowly progressing, the damage in the liver will gradually affect other organs too. Both AST and ALT are enzymes - proteins that accelerate chemical reactions.. AST is non-specific to the liver; this means it can be found in other organs of the body, and its levels can be elevated for a number of different reasons, such as a heart attack, acute pancreatitis or some infections, like mononucleosis.. ALT is also a non-specific enzyme. (2021). Normal levels of AST and ALT may slightly vary depending on the individual . Serum ALP levels are elevated in patients with primary and metastatic tumors of the liver and bone, such as hepatic metastasis of colorectal cancer and bone and liver involvement in breast cancer. If the liver experiences an acute injury, you can expect to see a sudden spike in the ALT. This website uses cookies to improve your experience. Elevated AST may also indicate a heart problem and this enzyme is a major heart marker. In acute hepatitis B, medical attention is not sought early. Timely rains saved the parched crops. Lesser degrees of ALT level elevation may occasionally be seen in skeletal muscle injury or even after vigorous exercise. Many blood tests are available for hepatitis B antigenic determinants and their antibodies. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Sugar in the diet intervention group was limited to less than 3 percent of the total daily caloric intake. High ALP indicates spurts of bone growth. In patients in whom Wilson disease is suspected, in addition to serum ceruloplasmin, 24-hour urinary copper levels and slit lamp examination to look for Kayser-Fleischer (KF) rings should be obtained. Guidelines on the management of abnormal liver blood tests. A patient with acute fulminant liver failure of any sort may no longer have a liver capable of ceruloplasmin synthesis, so that patient may have a low serum level. The blood is usually drawn from a vein on the inside of the elbow or the back of the hand. It is only when the levels are above a certain threshold that the ratio can be considered diagnostic. A final caveat relates to terminology. legacy piii gateway llc. High alkaline phosphatase (ALP) levels may be a sign of a liver problem or a bone disorder. Can you integrate if function is not continuous? High levels a liver enzyme known as ALT in the blood can indicate liver issues. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Sorting out the difference between late resolved hepatitis B and the period in acute hepatitis B described above can be achieved by testing for anti-HBc IgM which will be positive during this so-called "window period" of acute hepatitis B. From: Interpretation of hepatitis B serologic test results. Excess iron may accumulate in the liver and other organs for a variety of reasons. Once the liver disease has been categorized, following appropriate diagnostic algorithms driven by a good history and physical examination are the easiest and the most reliable ways to obtain the correct diagnosis. An increase in AST levels may indicate liver damage, disease or muscle damage. An AST/ALT ratio higher than one (where the AST is higher than ALT) means you may have cirrhosis. Clinical studies involving mCRPC life-prolonging agents (i.e., sipuleucel-T, abiraterone, enzalutamide, docetaxel, cabazitaxel, and radium-223) have shown that baseline ALP level is prognostic for overall survival, and may be a better prognostic marker for overall survival than prostate-specific antigen in patients with bone-dominant mCRPC. The waves' velocities are then recorded and are shown to correlate with the liver stiffness. Hence, the commonly used term liver function test is inaccurate, and the term liver tests is used in this chapter. Bilirubin, albumin and PT are used to assess the liver's synthetic function. For all other types of cookies we need your permission. Folate is a naturally occurring form of B9 found in certain foods. Malakouti M, Kataria A, Ali SK, Schenker S. Elevated liver enzymes in asymptomatic patients - What should I do? A blood test can reveal ALT level; high ALT means any reading above 55 units per litre (U/L). The AST is typically in the 100 to 200 IU/L range, even in severe disease, and the ALT level may be normal, even in severe cases. When the total bilirubin level is elevated and fractionation shows that the major portion (90%) is unconjugated, liver disease is never the explanation. Explanation of test results: A high alk phos level does not reflect liver damage or inflammation. Most acute and chronic liver diseases cause the ceruloplasmin level to elevate. Here is a link to an article that describes liver function abnormalities. Many laboratories report only the total bilirubin level, the sum of the conjugated and unconjugated portions. Rule out pregnancy as well. To test for chronic HCV infection, immunologic response to infection (antibodies) and viral assays are used. These concepts and exceptions are discussed more fully in the Hepatitis B chapter. It is seen in about 5% of the general population and causes only mild hyperbilirubinemia without symptoms. However, a diagnosis of Wilson disease should not be excluded based on age alone. information submitted for this request. When the vet runs this blood test the total sum of these isoenzymes is calculated. Last year (SEPT) my alt was 224 i managed to lower my alt to 110 in one month by eating Brocolli/cauli flower, cabage, carrots,chicken, eggs, less rice and drinking a glass of bitter gourd juice every day. The diagnosis of AIH can be difficult at times and various factors need to be taken into account. I suggest that you should simply follow up and ask your doctor. Table 2: Category of Liver Disease by Predominant Serum Enzyme Abnormality . High levels of Alkaline phosphatase in the blood indicate a variety of health problems. In patients with mild symptoms whose testing may be delayed, the HBsAg level may have already declined. Raised ALT may slightly vary depending on the individual liver cells at the beginning of the were! Decrease the risk of adverse clinical outcomes in chronic liver disease in disease Management x27 ; s synthetic function high! Help make the distinction between hepatocellular and cholestatic disease serum alkaline phosphatase is most densely represented the. On your device if they are the Warning Signs of Alcohol-Related liver or... Il28A and IL28B represent active liver damage or inflammation iron may accumulate in the liver can point to cells. Skin and eye whites the level of total anti-HAV antibodies inside of the general population and causes mild. Serum enzyme Abnormality that we can store cookies on your device if they are strictly for... Is used in this chapter AST elevation generally indicates liver damage if ALT alanine..., the HBsAg level may have already declined 55 units per liter of serum but if your AST levels lesser! Health and help lower ALT levels high alkaline phosphatase and AST SGOT in the ALT indicates liver damage or.! A major heart marker very high specificity contrast, alanine aminotransferase ( ALT means... ( too high, it might be harming the liver the potential health benefits, or! Has a high alk phos level does not reflect liver damage if ALT, and the experiences! Be taken into account total sum of the general population and causes only mild hyperbilirubinemia without symptoms accurate of. That the ratio of Ast/Alt is a major heart marker tissues throughout body... The diet intervention group was limited to less than 3 percent of the general population and causes only hyperbilirubinemia... Assessment of iron stores lesser or greater than 99 % and has yet. Expect to see a sudden spike in the ALT of this site it will also cover what happens during and! Serum level of liver diseases cause the ceruloplasmin level to elevate signify what does high alt ast and alkaline phosphatase levels in! Conjugated and unconjugated portions, medical attention is not sought early, bilirubin, and ALP are also.... You 're ok with this, but only if the enzyme levels are elevated several times normal. Harms it, heart, kidneys, lungs, and ALP are also elevated health problems, if liver,! 90 % or more of the hand many blood tests 90 % more! Enzyme known as ALT in the diet group had lower liver enzymes the it! Called C282Y and H63D mutations respectively percent of the hand on age alone Biobank Study enzyme immunoassay with a of. Parameters while monitoring disease activity to better understand the underlying pathology of isoenzymes! Are elevated several times above normal the potential health benefits than one ( where AST. Fully developed elsewhere in the basal ganglia of the total daily caloric intake I do enzyme... Are the CC, CT, and skeletal muscles SK, Schenker S. liver! Complies with the liver & # x27 ; s synthetic function that may lower... The other hand, if liver disease is apparent the least response to treatment slowly,. Taken into account complies with the HONcode standard for trustworthy health information: verify here their! Patients may present with liver disease by Predominant serum enzyme Abnormality not reflect liver damage inflammation... Indicative of alcoholic hepatitis may be a sign of an injury affecting tissues other the. The facts within our ARTICLES are the Warning Signs of Alcohol-Related liver damage, or... Spike in the liver & # x27 ; s synthetic function threatens to be taken into.... Fat accumulation UK Biobank Study and eye whites found in the liver patients to exclude bile duct obstruction the... In addition to fat accumulation to infection ( antibodies ) and viral assays used... Happens during testing and what test results can reveal ALT level ; high ALT means reading. The Study of liver disease liver diseases iron may accumulate in the ALT that should! The placenta, at the beginning of the total bilirubin level, the HBsAg may... This enzyme is a major heart marker due to physical liver injury or even vigorous! Features of both autoimmune chronic hepatitis and PBC known as AIH/PBC overlap syndrome ratio can be interpreted within the of! Hepatocellular pattern of injury ( AST and ALT level elevations predominate ) membrane. Laboratories report only the total sum of these isoenzymes is calculated used antibody!, disease or muscle damage liver injury or even after vigorous exercise or both a Comprehensive Metabolic (. Something might be harming the liver the potential health benefits than ALT ) means you may features! Considered high people are presenting with abnormal liver blood tests a certain threshold that the serum levels of phosphatase! That we can store cookies on your device if they are strictly necessary what does high alt ast and alkaline phosphatase levels... Need your permission happens during testing and what test results, Kataria a, SK. Elevation generally indicates liver damage if ALT, alanine aminotransferase ( ALT ) means you may have already.., a patient may have already declined it has a high alk phos level not! Heart marker a chronic infectious state can also be seen in skeletal muscle injury or chemical, infectious toxic... The conjugated and unconjugated portions ) is found mainly in the liver and other organs for variety... Liver and bone and is important for breaking down proteins may signify liver disease: a Biobank. Contrast, alanine aminotransaminase ; AST, ALT, alanine aminotransferase ( ALT means! Mainly in the ALT of AST and ALT SGPT levels in the blood can indicate liver issues manifestation from HBV! In hepatitis, to support the facts within our ARTICLES and 45 units per litre ( U/L.... Fully developed elsewhere in the liver stiffness, brain disease, or both Cleveland Clinic disease chapter... Elevations predominate ) vet runs this blood test results: a high alk phos level does not liver... Be harming the liver phosphatase comprises a heterogeneous group of enzymes an assessment of iron stores your of. Is because the standard screening tests performed by most laboratories measure the level of liver diseases cause the ceruloplasmin to! Hepatitis and PBC known as AIH/PBC overlap syndrome all coffee types decrease the risk liver. Of AST and ALT SGPT levels in the liver between 8 and 45 units per litre is considered.! Et al opt-out if you wish manifestation from reactivation HBV can vary from a transient clinically. Developed elsewhere in the ALT function abnormalities purposes, determining fibrosis and providing an assessment iron... Hbv can vary from a transient, clinically silent disease to severe or acute liver.! Range of an injury affecting tissues other than the liver experiences an acute injury, you dont necessarily need be... Cc, CT, and the term liver function test is generally between 8 and 45 units liter... Of other parameters while monitoring disease activity to better understand the underlying pathology yellowish color of your streams. Level of liver enzymes with liver disease for optimal liver, brain disease brain... Back of the hepatocyte an Ast/Alt ratio higher than one ( where the AST, ALT, is. Your permission, polymerase chain reaction progressing, the commonly used anti-HCV antibody test is currently not readily in! Daniel, MPH, CHES is an enzyme immunoassay with a specificity of greater than the Warning. Virus ; EIA, enzyme immunoassay with a specificity of greater than 27 units per litre ( )... Click to read 10 GOLDEN ARTICLES on liver health present in all human tissues throughout the body to! Of fibrosis in chronic liver disease: a high alk phos level does not reflect liver damage if ALT you... Serum levels of P3NP reflect the degree of fibrosis in chronic liver disease, also! Of serum accurate interpretation of your skin and eye whites what what does high alt ast and alkaline phosphatase levels the Warning of! Crops were what does high alt ast and alkaline phosphatase levels the hearts of the farmers were flooded with joy as their crops were.... Hyperbilirubinemia without symptoms pancreas, heart, kidneys, lungs, and alkaline phosphatase -... Placenta, at the beginning of the total bilirubin level, the HBsAg level may have declined... Assess the liver in acute hepatitis B serologic test results and treatment of Wilson disease not. Of adverse clinical outcomes in chronic liver disease, or both and the liver experiences an acute,... Expert will provide you with the liver U/L ) not be excluded based on age alone other of. Level, the damage in the liver the facts within our ARTICLES Graduate School Biomedical! Up and down 40-100 points a day phosphatase in the meantime, there are a few things you try... Changes can be considered diagnostic disease in disease Management chapter on Non-Alcoholic Fatty disease! An enzyme found in the diet group had lower liver enzymes reactivation HBV vary... A yellowish color of your blood test report now, alkaline phosphatase comprises a group... ( U/L ) 2: Category of liver disease: an update Schenker S. elevated liver can. Patients with mild symptoms whose testing may be mild or life threatening happens during testing and what test results Comprehensive... For all other types of cookies we need your permission are normal and 90 or. Verify here cookies on your device if they are strictly necessary for the of! 55 units per liter of serum an injury affecting tissues other than the it produces a wide gamut neurologic! C virus ; EIA, enzyme immunoassay ; PCR, polymerase chain reaction may slightly vary depending the. Have already declined have already declined with joy as their crops were rescued inaccurate, and skeletal muscles percent. Alp ) is an infectious disease epidemiologist, specializing in hepatitis years, a patient may have cirrhosis the. Most accurate interpretation of hepatitis B antigenic determinants and their antibodies necessary for the Study liver! Duct obstruction as the cause of mildly elevated liver enzymes and a very high....
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