Normal ALP at time of Diagnosis

[kerrypark]

Hello. I have had PBC for just over 3 years. I have always had a very normal ALP. I've read that one of the hallmarks of PBC is an elevated ALP. I have positive AMA and other elevated liver enzymes, now normal with urso. Can you explain why my ALP is normal? What does that indicate?

[JennerLayne]

My ALP is also normal, as well as my general labs (pre Urso). With a meld score of 7, I have had PBC quite a while apparently, as I am stage 4 cirrhosis per a biopsy in May I just started Urso / Bud / Aza last month but already have developed stomach bleeds (GAVE disease), GR1 esophageal varices and Portal Hypertension. I also have a DX of AIH and Sine Scleroderma / Systemic Sclerosis. Guess it goes to show how PBC impacts each individual differently.

Good luck to you!

[kerrypark in reply to JennerLayne]

PBC is such an unpredictable condition! Thank you for your response. And good luck to you too.

[periwinkle88]

I also have normal ALP. In my case, I was diagnosed with biopsy at stage 0 about ten years ago (and according to fibroscans I've had since, which were completely normal, it's still early stage). At that time, I also had positive AMA and slightly elevated ALT and AST. Like you, urso lowered the ALT and AST. My hepatologist has said that elevated ALP is an indicator of damage being done to the bile ducts, so in my case the normal ALP indicates that isn't yet happening yet because I'm still early stage. In addition, he said that it appears I have a milder variant of PBC, that presents as normal ALP with elevated ALT and AST. It appears on paper (labs) more like autoimmune hepatitis, with the normal ALP, and higher ALT and AST, but on biopsy it was PBC. I know that on the other end of the disease process—later stage—labs don't correlate to progression, as in you might have normal labs but be late stage. But that is not my case, and you may be in a similar situation.

[recipes in reply to periwinkle88]

Hello, to you guys I found reading about how your PBC is and your lab work. It is the way mine is and I have wonder why my ALP was normal but yet tested with PBC. I have just had my lab work done so I will see where I am. Thanks

[Brightlining]

I’m in the middle of diagnosis. Slightly elevated AST and ALT but normal ALP. High positive ANA with the pattern suggesting PBC and positive AMA. No symptoms but a mildly enlarged fatty liver and gallstones. Nothing else remarkable on my labs other than really low ferritin and really high B12. I’m waiting for a biopsy date.