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Wang C, Wang R, Tian X, Deng B, Gao Z, Zhang W, Liu X, Li Y, Qi X. An uncommon case of isolated elevation of aspartate aminotransferase in a young male. Intern Emerg Med 2024; 19:135-137. [PMID: 37358779 DOI: 10.1007/s11739-023-03347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Cai'e Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110840, China
| | - Ran Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiao Tian
- Department of Laboratory Medicine, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Baocheng Deng
- Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Zhenjiao Gao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Wenwen Zhang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Xuantong Liu
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yunhui Li
- Department of Laboratory Medicine, General Hospital of Northern Theater Command, Shenyang, 110840, China.
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China.
- Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110840, China.
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Pei X, Zhao Y, Jiang W, Zeng Q, Liu C, Wang M, Wang H, Liang S, Gan W, Wu D, Tang H. Persistently high serum aspartate aminotransferase level in an asymptomatic young patient. Clin Case Rep 2023; 11:e7912. [PMID: 37700775 PMCID: PMC10493240 DOI: 10.1002/ccr3.7912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023] Open
Abstract
Key Clinical Message We report a young man with isolated elevated AST. He had no other evidence of liver or other related diseases. All the tests and examination reports were negative. The final diagnosis of macro-AST was confirmed by PEG precipitation tests. Abstract Elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), may commonly indicate liver injury. However, macro-AST is generally a benign condition that may be considered as pathologic by clinicians. A young man with isolated elevated AST for more than 10 years who have taken extensive tests and examinations was diagnosed with macro-AST in our article. Thus, in patients with isolated AST-elevation, polyethylene glycol (PEG) precipitation test was recommended to test whether macro-AST could be diagnosed.
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Affiliation(s)
- Xiong Pei
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Yanhua Zhao
- Department of Laboratory MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Wei Jiang
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Qingmin Zeng
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Changhai Liu
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Wang
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Hui Wang
- Department of Laboratory MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Shanshan Liang
- Department of Laboratory MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Wei Gan
- Department of Laboratory MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Dongbo Wu
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Hong Tang
- Center of Infectious DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Aleknavičiūtė-Valienė G, Černiauskas L, Riauka M, Vitkus D. Macro-Aspartate Aminotransferase and Its Laboratory Detection: A Case Report. Acta Med Litu 2023; 30:181-187. [PMID: 38516513 PMCID: PMC10952419 DOI: 10.15388/amed.2023.30.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 03/23/2024] Open
Abstract
Background Increased enzyme activity in human blood serum is usually associated with the existence of disease. On the other hand, enzyme activity can also be elevated in the presence of benign conditions, such as macro-enzymes. Macro-enzymes could lead to highly unnecessary and invasive procedures which may cause complications to the patient and an extra cost for the hospital. Therefore, it is important to diagnose this condition in order to avoid unnecessary clinical tests. Case Presentation We present a case of a 71-year-old asymptomatic female with persistent elevation of AST who was referred to our hospital for additional testing for underlying liver disease. By using polyethylene glycol (PEG) precipitation assay, we were able to identify macro-AST. This helped to avoid the high-risk liver biopsy procedure. Conclusion In the case of an isolated elevation of AST activity with no clinical indications of liver disease, diagnostic work-up for macro-AST should always be considered by physicians.
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Affiliation(s)
| | - Linas Černiauskas
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mantas Riauka
- Center of Internal Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dalius Vitkus
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Čásenská J, Franeková J, Mačinga P, Jabor A. Significant elevations of serum amylase caused by macroamylase: Case reports and detection possibilities. J Clin Lab Anal 2023; 37:e24859. [PMID: 36916750 PMCID: PMC10098064 DOI: 10.1002/jcla.24859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The presence of isolated elevated serum amylase levels can be caused by high molecular mass complexes. We describe 13 cases of hyperamylasemia detected in adult patients without clinical symptoms of a pancreatic disorder. Five of them were thoroughly examined using different tools for the detection of macrocomplexes. METHODS We performed both screening and more advanced methods of macroamylase detection, including polyethylene glycol precipitation, sample storage at 4°C and separation by gel filtration. RESULTS The presence of macroamylase in the suspected samples was confirmed by the methods described, except for the sample storage at 4°C. In this method, the enzyme activity did not decrease. The polyethylene glycol precipitation activity (% PPA) averaged 89.1% for amylase, whereas the control samples averaged 30.7%. Gel filtration chromatography confirmed an IgA macroamylase peak in three samples and an IgG macroamylase peak in two samples. CONCLUSION The presence of macroamylase should be suspected whenever the clinical history and condition of the patient do not match the measured enzyme value to avoid diagnostic errors and unnecessary invasive examinations. The presence of macrocomplexes is considered a benign process that may occur in apparently healthy individuals. Cooperation between clinicians and laboratory staff is necessary.
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Affiliation(s)
- Jitka Čásenská
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Janka Franeková
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Peter Mačinga
- Department of Hepatology and Gastroenterology, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
| | - Antonín Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
- Third Faculty of Medicine, Charles University, Praha, Czech Republic
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Muñoz-Prieto A, Cerón JJ, Rubio CP, Contreras-Aguilar MD, Pardo-Marín L, Ayala-de la Peña I, Martín-Cuervo M, Holm Henriksen IM, Arense-Gonzalo JJ, Tecles F, Hansen S. Evaluation of a Comprehensive Profile of Salivary Analytes for the Diagnosis of the Equine Gastric Ulcer Syndrome. Animals (Basel) 2022; 12:ani12233261. [PMID: 36496782 PMCID: PMC9740180 DOI: 10.3390/ani12233261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
In this report, the measurement of salivary biomarkers as an aid for diagnosis of equine gastric ulcer syndrome (EGUS) was studied. A comprehensive panel of 23 salivary analytes was measured in the saliva of horses affected by EGUS and compared to healthy animals and horses with other diseases clinically similar to EGUS but with a negative diagnosis at gastroscopic examination. A total of 147 horses were included in the study and divided into heathy population (n = 12), the EGUS group (n = 110), and the group of horses with other diseases (n = 25). From the 23 analytes studied, 17 showed increased values in EGUS horses when compared to healthy ones, and uric acid, triglycerides, and calcium were significantly increased in horses with EGUS compared to the group of other diseases. The receiver operating characteristic curve analyses showed a modest but significant discriminatory power of those three analytes to identify EGUS from other diseases with similar symptoms. The discriminatory power enhanced when the results of the three analytes were combined. In conclusion, the results showed that selected salivary analytes could have potential use as biomarkers in horses with EGUS.
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Affiliation(s)
- Alberto Muñoz-Prieto
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - José J. Cerón
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
| | - Camila P. Rubio
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
| | - María Dolores Contreras-Aguilar
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
| | - Luis Pardo-Marín
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
| | - Ignacio Ayala-de la Peña
- Animal Medicine and Surgery Department, Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
| | - María Martín-Cuervo
- Animal Medicine, Faculty of Veterinary Medicine of Cáceres, University of Extremadura, Av. de la Universidad S-N, 10005 Cáceres, Spain
| | - Ida-Marie Holm Henriksen
- Department of Veterinary Clinical Sciences, Veterinary School of Medicine, Sektion Medicine and Surgery, University of Copenhagen, Hoejbakkegaard Allé 5, DK-2630 Høje-Taastrup, Denmark
| | - Julián J. Arense-Gonzalo
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, 30120 Murcia, Spain
- Division of Preventive Medicine and Public Health Sciences, School of Medicine, University of Murcia, Espinardo, 30100 Murcia, Spain
| | - Fernando Tecles
- Interdisciplinary Laboratory of Clinical Analysis of the University of Murcia (Interlab-UMU), Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Campus de Espinardo s/n, Espinardo, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-868887082
| | - Sanni Hansen
- Department of Veterinary Clinical Sciences, Veterinary School of Medicine, Sektion Medicine and Surgery, University of Copenhagen, Hoejbakkegaard Allé 5, DK-2630 Høje-Taastrup, Denmark
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Lewis JH, Khaldoyanidi SK, Britten CD, Wei AH, Subklewe M. Clinical Significance of Transient Asymptomatic Elevations in Aminotransferase (TAEAT) in Oncology. Am J Clin Oncol 2022; 45:352-365. [PMID: 35848749 PMCID: PMC9311471 DOI: 10.1097/coc.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Monitoring for liver injury remains an important aspect of drug safety assessment, including for oncotherapeutics. When present, drug-induced liver injury may limit the use or result in the discontinuation of these agents. Drug-induced liver injury can exhibit with a wide spectrum of clinical and biochemical manifestations, ranging from transient asymptomatic elevations in aminotransferases (TAEAT) to acute liver failure. Numerous oncotherapeutics have been associated with TAEAT, with published reports indicating a phenomenon in which patients may be asymptomatic without overt liver injury despite the presence of grade ≥3 aminotransferase elevations. In this review, we discuss the occurrence of TAEAT in the context of oncology clinical trials and clinical practice, as well as the clinical relevance of this phenomenon as an adverse event in response to oncotherapeutics and the related cellular and molecular mechanisms that may underlie its occurrence. We also identify several gaps in knowledge relevant to the diagnosis and the management of TAEAT in patients receiving oncotherapeutics, and identify areas warranting further study to enable the future development of consensus guidelines to support clinical decision-making.
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Affiliation(s)
| | | | | | - Andrew H. Wei
- The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Marion Subklewe
- University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Magen‐Rimon R, Tal G, Kaplan M, Shaoul R. The significance of isolated aspartate aminotransferase elevation in healthy paediatric patients. Acta Paediatr 2022; 111:675-679. [PMID: 34564873 DOI: 10.1111/apa.16123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 01/21/2023]
Abstract
AIM Aspartate aminotransferase (AST) is an enzyme expressed in several organs; therefore, AST elevation may reflect outside of liver pathology. AST elevation may also be associated with macro-AST (m-AST). The aim of this study was to evaluate the long-term course of children with prolonged isolated AST elevation and the prevalence of m-AST in our cohort. METHODS We retrospectively reviewed the medical charts of children diagnosed with prolonged isolated AST elevation and were evaluated for m-AST. RESULTS Thirty-two patients were included. AST elevation persisted for a median of 66.6 months and ranged from 1.23 to 12-fold upper limit of normal (ULN). Twenty-two percent were m-AST positive and 44% had borderline levels of m-AST. A statistically significant difference was found for age at presentation between the borderline and the positive m-AST groups (31 vs. 69 months, respectively. p = 0.045). None of the patients with elevated AST developed significant liver disease. CONCLUSION We confirm the benign course of prolonged isolated AST elevation in general and m-AST in particular. A fifth of the patients with isolated AST elevation were m-AST positive. No differences have been found in AST levels between negative, borderline or positive m-AST.
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Affiliation(s)
- Ramit Magen‐Rimon
- Pediatric Gastroenterology & Nutrition institute Ruth Children's Hospital of Haifa Rambam Medical Center Faculty of Medicine Technion Haifa Israel
| | - Galit Tal
- Metabolic Clinic Ruth Rappaport Children’s Hospital Rambam Health Care Campus Haifa Israel
- Pediatric B Department Ruth Rappaport Children’s Hospital Rambam Health Care Campus Haifa Israel
| | - Marielle Kaplan
- Biochemistry Laboratory Rambam Health Care Campus Rappaport Faculty of Medicine Technion Haifa Israel
| | - Ron Shaoul
- Pediatric Gastroenterology & Nutrition institute Ruth Children's Hospital of Haifa Rambam Medical Center Faculty of Medicine Technion Haifa Israel
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Lorubbio M, Ognibene A, Salvadori B, Fanelli A, Laffi G. Macro-aspartate aminotransferase in a healthy woman. Clin Mol Hepatol 2020; 26:378-381. [PMID: 32570300 PMCID: PMC7364350 DOI: 10.3350/cmh.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Maria Lorubbio
- General Laboratory, Laboratory Department Careggi Hospital, Florence, Italy
| | - Agostino Ognibene
- General Laboratory, Laboratory Department Careggi Hospital, Florence, Italy
| | | | - Alessandra Fanelli
- General Laboratory, Laboratory Department Careggi Hospital, Florence, Italy
| | - Giacomo Laffi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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