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Interpret
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Reading File
Searching the Web
AASLD elevated aminotransferases mild ALT evaluation guidance metabolic dysfunction associated steatotic liver disease
Searching PubMed
elevated aminotransferases AND metabolic dysfunction-associated steatotic liver disease
Finding Sources
Finding Sources
Finding Sources
Overall
The main findings are:
- Vitamin B12 deficiency
- Vitamin D insufficiency
- Moderately elevated ALT with borderline AST elevation, a liver-cell irritation pattern
- Borderline-high triglycerides
- Urine microscopy is generally reassuring, except for calcium oxalate crystals
There is no obvious urine infection, thyroid abnormality, low platelet count, or evidence of impaired liver protein production in these pages.
Abnormal or notable results
| Test | Result | Interpretation |
|---|---|---|
| Vitamin B12 | 142 pg/mL | Low. Lab range 211-912 |
| 25-OH Vitamin D | 25.04 ng/mL | Insufficient/low. Lab range 30-100 |
| ALT/SGPT | 94.4 U/L | Elevated, about 1.9 times lab upper limit |
| AST/SGOT | 50.44 U/L | Borderline elevated |
| Indirect bilirubin | 1.0 mg/dL | Mildly high |
| Triglycerides | 196.8 mg/dL | Borderline high, close to 200 |
| LDL cholesterol | 104.85 mg/dL | Near-optimal, mildly above the stated ideal target of <100 |
| VLDL | 39.36 mg/dL | Elevated, consistent with the triglyceride level |
| Globulin | 2.88 g/dL | Slightly low |
| Lymphocyte percentage | 44.9% | Mildly high by percentage, but absolute lymphocyte count is normal |
| MPV | 10.7 fL | High, but platelet count is normal, so isolated elevation is usually not concerning |
Liver tests: the priority item
ALT 94.4 and AST 50.4 indicate a mild hepatocellular enzyme elevation. ALT is higher than AST, while ALP, GGT, albumin, total protein, and total bilirubin are normal or near-normal. This suggests liver inflammation/irritation rather than bile-duct blockage or reduced liver function.
A common cause in this pattern, especially alongside raised triglycerides, is fatty liver related to metabolic factors, now called MASLD. But this is not confirmed from blood tests alone. Other causes should be considered: alcohol intake, recent heavy exercise, medicines or supplements, viral hepatitis B/C, and less commonly autoimmune or other liver disorders. AASLD notes that MASLD is often found incidentally with mild AST/ALT elevations and is associated with high cholesterol/triglycerides and other metabolic risks AASLD clinical overview.
What to discuss with a clinician soon, ideally within 1-2 weeks:
- Repeat LFT after avoiding alcohol, unnecessary supplements, and strenuous exercise for several days, if applicable.
- Review all medicines, gym products, herbal/Ayurvedic products, and alcohol intake.
- Check fasting glucose or HbA1c, blood pressure, waist/BMI.
- Hepatitis B surface antigen and hepatitis C antibody, if not already tested.
- Consider an abdominal ultrasound for fatty liver.
- If enzymes remain raised for more than about 3 months, a clinician may consider further evaluation, including fibrosis assessment. Non-invasive scores and elastography are more useful than liver enzymes alone for fibrosis assessment EASL MASLD guideline.
Using the available age, AST, ALT, and platelet count, an approximate FIB-4 is 0.9, which is low-risk for advanced liver scarring. This is reassuring, but it does not identify the cause of the ALT rise and should be interpreted by your doctor.
Vitamin B12: genuinely low
A B12 of 142 pg/mL is low and should be treated after clinical review. It can cause fatigue, mouth or tongue soreness, tingling/numbness, balance problems, memory or concentration difficulty, and anemia. Nerve symptoms can occur even before anemia is apparent.
Ask for:
- The missing first page of the CBC, especially hemoglobin, MCV, and RDW
- Dietary review, especially if vegetarian/vegan
- Assessment for poor absorption, acid-suppressing medication use, metformin use, or stomach/intestinal conditions
- B12 replacement plan from your clinician, usually oral high-dose therapy or injections depending on symptoms and cause
- Follow-up CBC and B12 level after treatment
If you have numbness, burning feet, gait imbalance, or worsening neurologic symptoms, seek medical assessment promptly rather than delaying treatment.
Vitamin D
At 25 ng/mL, vitamin D is insufficient. It is not a medical emergency, but it is reasonable to correct it with clinician-guided vitamin D supplementation, adequate dietary calcium, and safe sunlight exposure. The exact dose should depend on your medical history, kidney-stone history, calcium level, and clinician preference.
Cholesterol and triglycerides
- Total cholesterol 190: desirable
- HDL 46: acceptable
- Triglycerides 196.8: borderline high
- LDL 104.9: near-optimal
- Total cholesterol/HDL ratio 4.13: within this lab’s range
The triglyceride level can rise with excess sugars/refined carbohydrates, alcohol, overweight, diabetes/prediabetes, or a non-fasting sample. The combination of triglycerides and ALT elevation makes metabolic fatty liver a reasonable possibility to assess.
Practical steps:
- If this was not fasting, repeat a fasting lipid profile.
- Limit alcohol, sugary drinks, sweets, fruit juice, bakery foods, and refined carbohydrates.
- Aim for regular aerobic exercise and gradual weight reduction if overweight.
- Check HbA1c or fasting glucose.
Urine report
This is mostly normal:
- No leukocyte esterase, bacteria, or significant pus cells: no evidence of UTI
- No blood/RBCs
- Calcium oxalate crystals seen: common and does not by itself mean a stone. It can occur with concentrated urine, dietary oxalate, or vitamin C intake.
Drink enough water to keep urine pale yellow, unless you have a fluid restriction. Seek care if you develop flank pain, severe colicky pain, fever, vomiting, or visible blood in urine.
Blood count items shown
- Platelets: 204,000/µL, normal.
- Absolute neutrophil count: 2.10, low-normal but within range.
- Absolute lymphocyte count: 2.10, normal. The raised lymphocyte percentage alone is not concerning.
- High MPV with normal platelet count is commonly nonspecific and usually does not require action by itself.
Seek urgent care now if
Yellow eyes/skin, dark urine, severe upper-right abdominal pain, persistent vomiting, confusion, marked drowsiness, fever with abdominal pain, or rapidly worsening weakness occurs.
The next useful medical review should focus on the raised ALT/AST, B12 replacement, vitamin D correction, and metabolic screening.
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