Dear Dr. Berger,
My 37-year-old daughter underwent a biopsy because of some liver test abnormalities -- AMA and ALP. Can you please explain what values of the tests are normal and which can indicate a problem?
I want to suggest a rule which seems simple on its face but can easily be forgotten in the flood of medical information. A laboratory result, for example, a blood test, is only useful in order to better understand what is happening with the patient. It is very rare for one result, one number, to reveal the whole secret of a person’s health.
For example, let's take the liver. An ordinary panel of tests includes 5 or 6 numbers, which might describe different functions of that organ. But not every numerical abnormality implies a significant abnormality, let alone an important disease in the liver. Certain frequently ordered liver tests (e.g., the AST and ALT) can be elevated due to hepatitis, viral infections, or even medications. Sometimes, an abnormality is just random, due to the laws of chance.
In short, no test is perfect. Everything must be considered in context -- in medicine and in life. When a healthy person gets a bunch of tests at once (according to the routine in American doctors’ offices, which is not necessarily supported by the evidence), some of them will probably come back as “abnormal,” just because of statistics. A doctor, and a patient too, should consider the importance and severity of the symptoms to help understand the relevance (or lack thereof) of the lab results.
Your daughter’s case seems somewhat different. Unfortunately we already know that something is wrong with her liver. Presumably the laboratory tests are important, but now -- as you relate -- doctors are trying to connect those results with the biopsy. An advice column isn’t necessary here; rather, a doctor has to sympathetically and knowledgeably consider the patient’s needs face to face, appreciating her individual needs and her environment. Best of health to her.