Poster Name: Jonathan Kraf
Category: (Speaker/Oral Presentation)
Location: US
Track Name: Hepatology
Research interest: Novel Biomarkers, Innovation and Technologies in Gastroenterology and Emerging Cancer Treatments
J. C. Kraft1
and E. W. Chak1
,
1Division of Gastroenterology and Hepatology 4150 V Street, PSSB 3500 Sacramento, CA 95817
Biography: Jonathan Kraft completed his B.Sc. from the University of British Columbia. He is currently applying to medical schools across North America and this is his first conference presentation in the medical field.
Eric Chak completed his MD from the University of California, San Francisco and Gastroenterology fellowship at the University of California, Los Angeles. He is currently Associate Professor at the University of California, Davis, Division of Gastroenterology and Hepatology and Principal Investigator of a National Institutes of Health grant—investigating the use of electronic population health tools to improve health care delivery to older adults
Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Introduction: A 45-year-old woman with no previous medical history was diagnosed with anemia and elevated alkaline phosphatase (ALP). She was referred to hepatology for evaluation. Initial laboratories showed ALP 746 IU/L, gamma glutamyl transferase 303 IU/L hemoglobin of 10.1 g/dl, mean corpuscular volume 72.8 fL, iron saturation 6.2%, total iron binding capacity 195 ug/dL, and ferritin 506. Therefore, she was diagnosed with mixed iron deficiency anemia and anemia of chronic disease. Inflammatory markers were significantly elevated as c-reactive protein was 17.5 mg/dl and erythrocyte sedimentation was 106 mm/hr. Total bilirubin, aspartate transaminase, and alanine transferase were normal. For work up of anemia, a colonoscopy and upper endoscopy were performed showing a normal colon and severe candida esophagitis, which was subsequently treated with fluconazole. Capsule endoscopy was normal.
Her ALP rose to 889 IU/L and a liver biopsy was performed showing no significant fibrosis, normal bile ducts, and no significant portal or lobular inflammation. An echocardiogram showed no evidence of heart failure. During follow up, a newly identified hard and immobile 2 cm supraclavicular lymph node was appreciated on examination. A lymph node biopsy was performed, confirming a diagnosis of Hodgkin’s Lymphoma. PET/CT scan confirmed Stage IIIA disease. Her ALP normalized with successful chemotherapy treatment of lymphoma.
Elevated ALP has been associated with chronic inflammation especially in women [1,2]. The absence of hepatic pathology in this case along with reports of elevated ALP in cases of lymphoma, solid organ malignancy, rheumatologic disease, infection, coronary artery disease, and obesity further supports the notion that ALP may not solely be a marker of liver injury, but a non-specific marker of extrahepatic chronic inflammation [3,4,5,6,7,8,9,10,11,12,13]. While the mechanism of ALP elevation in these situations remains uncertain, our case suggests that upon ruling out the usual causes of ALP elevation, extrahepatic sources should be considered [14,15,16,17].
Keywords: Alkaline Phosphatase, Chronic Inflammation, Hodgkin’s Lymphoma
References: [1] Ralph E. et al. (1974) Cancer, 33, 1123- 1126. [2] Cheung M.Y. et al. (2008) Clinical Chemistry and Laboratory Medicine, 46, 523-527. [3] Siref A. et al. (2018) The American Journal of Dermatopathology, 40, 927-929. [4] Li J. et al. (2018) Medicine, 97. [5] Lee D. et al. (2021) Medicine Case Reports and Study Protocols, 2. [6] Livesay S. and Ruppert S.D. (2012) Critical Care Nursing Quarterly, 35, 160-172. [7] Peters A. and Prickett M. (2021) Critical Care Explorations, 3. [8] Abulaimoun S. et al. (2020) ACG Case Reports Journal, 7. [9] Sethi P.P. et al. (2021) BMJ Case Reports, 14. [10] Zanetti D. et al. (2020) Circulation: Genomic and Precision Medicine, 13. [11] Sangha S. et al. (2021) JCR: Journal of Clinical Rheumatology, 27. [12] Lui D. et al. (2019) Medicine, 98. [13] Sun P. et al. (2018) Medicine, 97. [14] Ji F. et al. (2016) Medicine, 95. [15] Haarhaus M. et al. (2017) Nature Reviews Nephrology, 13, 429- 442. [16] Rader B.A. (2017) Frontiers in Immunology, 8. [17] Rajab I.M. et al. (2020) Biophysics Report, 6, 49-67.
Tags
Crohn’s and Colitis Journals | Gastroenterology & Hepatology Journals | Gastroenterology Journals | Research Gastroenterology and Hepatology Journals | Clinical and Experimental Gastroenterology Journals | Gastrointestinal Endoscopy Journals | Therapeutic Advances in Gastroenterology Journals | Colorectal Disease: clinical and molecular gastroenterology and surgery Journals | Inflammatory Bowel Diseases Journals | Expert Review of Gastroenterology & Hepatology Journals | Clinical Colorectal Journals | Cancer Gut Journals | Endoscopy Journals | Hepatitis B Annual Journals | Hepato-biliary-Pancreatic Sciences Journals | Medical Bulletin Journals
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