David Alter

All articles by David Alter

Abnormal Test Result in the Lipid Profile

Differential Diagnosis Elevated total cholesterol Elevated LDL cholesterol Continue Reading Decreased HDL cholesterol Increased fasting triglyceride Suggested Additional Lab Testing Total cholesterol level Can be performed on serum or plasma Can be obtained fasting or non-fasting HDL cholesterol Can be performed on serum or plasma Can be obtained fasting or non-fasting LDL cholesterol level Pt…

Abnormal Platelet Aggregation Studies

Differential Diagnosis Acquired causes of platelet dysfunction: Ingestion of aspirin or aspirin-like compounds or NSAIDs Impaired renal functionContinue Reading Myeloproliferative disease Exposure to cardiopulmonary bypass Presence of a paraprotein Congenital causes of platelet dysfunction: Storage pool disease Glanzmann thrombasthenia Bernard-Soulier syndrome Disorders of thromboxane production or action Suggested Additional Lab Testing Platelet aggregation studies with…

Abnormal Liver Function Tests: Elevations in ALT and AST, Which Predominate Over Elevations of Alkaline Phosphatase (ALP), 5'-NT, and/or Gamma Glutamyltransferase (GGT)

Differential Diagnosis If the diseases in the list below increase in severity, there may be findings suggestive of cirrhosis with or without hepatic failure: Viral hepatitis, multiple forms (see chapters on Viral Hepatitis A, B, and C) HemochromatosisContinue Reading Wilson disease Alpha-1-antitrypsin deficiency Hepatocellular carcinoma Suggested Additional Lab Testing Total bilirubin and unconjugated bilirubin are…

Abnormal Liver Function Tests: Elevated Serum Bilirubin and/or Predominant Elevations in ALP, 5'-NT, and/or Gamma Glutamyltransferase (GGT)

Differential Diagnosis Red blood cell (RBC) hemolysis from a variety of causes Obstruction of the biliary tract from any of the several possibilities Continue Reading Intrahepatic biliary diseases: primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) Hereditary conjugated hyperbilirubinemias: Dubin-Johnson syndrome, Rotor syndrome Hereditary unconjugated hyperbilirubinemias: Criggler-Najjar syndrome type I, Criggler-Najjar syndrome type II, Gilbert…

A Positive Test for Hypercoagulability

Differential Diagnosis Presence of factor V Leiden (can be heterozygous or homozygous) Presence of prothrombin 20210 mutation (can be heterozygous or homozygous) Continue Reading Presence of antiphospholipid antibody; could be manifested as lupus anticoagulant or anticardiolipin antibodies or anti-beta 2 glycoprotein 1 antibodies (IgG, IgM, IgA) Elevated homocysteine Deficiency of protein C not produced by…

Dubin Johnson syndrome

At a Glance A genetic condition that results in an elevated serum bilirubin level. What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful? Elevated total bilirubin Continue Reading Elevated direct bilirubin No evidence of biliary tract obstructive disease process Normal levels of AST, ALT, GGT and…

Crigler Najjar Disease

At a Glance Crigler Najjar disease is a genetic abnormality that results in a persistent elevation of total bilirubin. What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful? Elevated total bilirubin Elevated indirect (unconjugated) bilirubinContinue Reading No evidence of hemolysis related process Type 1 markedly elevated…

Gilbert's Disease

At a Glance This is a genetic abnormality that results in an elevated bilirubin What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful? Elevated to normal total bilirubin, no greater than 3 mg/dL Continue Reading Elevated (mildly) indirect (unconjugated) bilirubin No evidence of hemolysis related process

Alcoholic Liver Disease (ALD)

At a Glance No biochemical markers pathognomonic for alcoholic liver disease (ALD) exist. The diagnosis has to start with evidence of alcohol abuse either from a history of documented blood alcohol levels or from response to one of the questionnaires desired to elicit a history of ongoing alcohol abuse. What Tests Should I Request to…

Liver, Failure

At a Glance Acute liver failure (ALF; fulminant hepatic failure, fulminant hepatitis, or ischemic necrosis) is a catastrophic, rapid deterioration of liver function in previously healthy individuals without any history of liver disease (>26 weeks in duration) in combination with coagulopathy (International Normalized Ratio (INR) > 1.5) and encephalopathy to complete the diagnostic criteria. There…

Next post in LabMed