Q. Do elevated bilirubin and low platelets with a history of alcohol consumption indicate liver cirrhosis?

Answered by
Dr. Sandeep V Nair
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 08, 2020 and last reviewed on: Oct 14, 2020

Hello doctor,

I am very concerned about my liver. I have a history of alcohol use of approximately two to four beers per night, approximately five nights per week for nearly 20 years. I am under total abstinence for the past one year.

My symptoms are aching pain in the back on the right side under the rib cage (worse the longer I stand up), total loss of libido with erectile dysfunction.

Recent blood labs showed AST 17, ALT 20, ALP 69, GGT 15, albumin 4.62, but elevated bilirubin at 0.52 direct and 0.64 indirect (total bilirubin -1.16), and low platelets at 127. Prior blood labs from one and a half years ago showed elevated bilirubin at 1.7 (total) and platelets at 158. However, platelets were also at 127, just one week before when they were measured at 158. Despite total bilirubin being lower than before, I can now notice slight jaundice on the skin of my face and on my fingers, but no one else seems to notice this.

Is there concern for cirrhosis given the low platelets, elevated bilirubin, and erectile dysfunction? Are the APRI score (0.34) and fib-4 score (1.17) useful in ruling out fibrosis in my case? Or might the AST be misleading in this case? What should someone do in my case? Is it possible that there is liver inflammation from too much alcohol for many years? Is a fibroscan recommended?



Welcome to icliniq.com.

Given the amount of alcohol that you are taking and the duration you have taken, it is likely that you can develop cirrhosis. But the development of cirrhosis is a gradual process, and it takes a long time before it is evident on the tests.

Fibroscan is a useful modality to assess liver stiffness and hence can tell you whether the liver is fibrotic with good accuracy. APRI and fib 4 are not very accurate.

You can get an ultrasound of the abdomen with splenoportal axis Doppler study, which will tell whether there is ongoing portal hypertension.

Increased echotexture of the liver, shrunken liver with nodular surface, and spleen enlargement are all evidence for cirrhosis of the liver. I would also suggest that you undergo serum ferritin, transferrin saturation to rule out hemochromatosis as you have skin pigmentation, and erectile dysfunction. Also, other etiologies should be ruled out by the following tests.

1. HBsAg (surface antigen of hepatitis B virus).

2.Anti HCV (hepatitis C virus).

3. Ceruloplasmin.

Thank you doctor,

As a follow-up, would you say it is a good sign that the bilirubin level has come down from 1.7 to 1.16 over the course of one and a half years? Would this suggest anything about the stage of liver disease or possible regression of disease?



Welcome back to iclniq.com.

Bilirubin level drop is a good sign, but that is not enough. It is a nonspecific marker of the stage of liver disease. Ultrasound of the liver and endoscopy are more valuable tests to assess the stage of liver disease.

If there are findings of portal hypertensive gastropathy or varices on endoscopy that suggest progression of liver disease. The liver is an organ with immense potential for regeneration, provided you give it time to heal and do not repeat the injury on it. So the bottom line is abstinence.

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