Need help understanding labs/disease

[Margie]

Last weeK I received the first Comprehensive Metabolic Panel results that I have ever seen before. I need some help translating them. If any of you can help, I would appreciate it. I don't see the doctor again for a month & the nurse faxed these to me after the results came back.

Bun/Crea High at 24. Normal 6-22

Alb/Glob Low at 0.92 Normal 1.00-2.10

AST High at 63.00 Normal 15.00-37.00

ALT High at 124.00 Normal 30-65.

Thanks

[Birgitta-A]

Hi Margie,
The BUN/creatinine ratio is the ratio of two serum laboratory values, the blood urea nitrogen (BUN) and serum creatinine.

The BUN test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passes out of your body in the urine.

A BUN test is done to see how well your kidneys are working. If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher.

The level of creatinine in your blood also tells how well your kidneys are working; a high creatinine level may mean your kidneys are not working properly.

24 instead of 22 is really not a significant increase – perhaps you eat much protein, that is valuable for your body.

Albumin/Globulin: The major measured serum proteins are divided into two groups, albumin and globulins. Normally, there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease states affect the relative changes in albumin and globulins in different ways, this may provide a clue to your doctor as to the cause of the change in protein levels. A low A/G ratio may reflect overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases, or underproduction of albumin, such as occurs with liver cirrhosis, or selective loss of albumin from the circulation, as occurs with kidney disease.

AST and ALT: Among the most sensitive and widely used of the liver enzymes are the aminotransferases. They include aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These enzymes are normally contained within liver cells. If the liver is injured, the liver cells spill the enzymes into blood, raising the enzyme levels in the blood and signaling the liver damage.

You should not drink alcohol when AST and/or ALT are high and avoid everything else for example drugs like painkiller, that could damage the liver. The liver has much overcapacity – you manage well with 1/3 of the liver.
Kind regards
Birgitta-A

[Margie]

Thank you kindly, Birgitta-A.

Could these test numbers be connected to iron overload caused by a large number of transfusions do you think?










MDS dx 2003. Three lines - all now critically low. Transfusion dependent.

[Birgitta-A]

Hi Margie,
Yes, the liver tests AST and ALT can increase if you have iron overload.

The test that tells you more about iron overload is the ferritin level - if it is less than 1000 you don't have iron overload.

How many units of packed red blood cells have you received?
Kind regards
Birgitta-A
70 yo, transfusion dependent since dx May 2006 (have now received 94 units of blood), Neupogen 2 injections/week for low white blood cells, last platelet count 43.

[Margie]

Brigitta - A

I have had about 44 units of red cells. I do have iron overload. Early this year, the ferritin level was a little over 2700. I haven't heard since, but will surely at my next doctor's visit. It will increase rapidly now that I need transfusions about every two weeks.

I needed a second opinion before I talk to the hemotologist about the recent CMP results. You are my second opinion. The doctor keeps holding off on Exjade because he feels that I won't be able to take it. There is something wrong with my digestive track, and I have an infection and temperature (sometimes high) about three fourths of the time. I also have a very sensitive stomach.

I would feel better trying Desferal anyway, but my hemotologist has never used it. Also, the State of Texas Medicare doesn't recogonize Desferal as a medicine: the agent could not find it on any of their lists.

Thank you once again.
Margie

[launch]

Margie,
In your post you said you do have an infections and temperatures 3/4 of the time. I wanted to let you know, my husband, dx with MDS Feb'09 had nightly fevers every single night until his hemaglobin was stablized. That only happened, for him, after his 1st cycle of Vidaza and his last transfusion during that same cycle.

Although he didn't have infections, I did want to bring up the "Fever" being possibly related to the MDS condition itself like my husband's was. He would sweat so much he had to sleep on a towel...

We're thankful he no longer has this problem.
Cindy

[Birgitta-A]

Hi Margie,
You know Desferal (deferoxamine from Novartis) has been used about 40 years for iron overload all over the world. If your doctor isn’t used to work with Desferal you could consider changing doctor.

In Sweden Desferal is given for 4 days with transfusion with a small home pump (looks like a lemon) through a port-a-cath, that has to be inplanted in the upper part of your chest.

I have had no problems with transfusions or Desferal since I got my port-a-cath (Jan 2007) 8 months after dx. Desferal has not given me any adverse reactions.

Here is a link about iron overload including Desferal
http://www.desferal.com/index.jsp

Cindy has already told you the you can get fever from having a cancer disease like MDS – it is some of the so called cytokines that can cause fever.
Kind regards
Birgitta-A