Elevated Fetal Protein Levels: Next Steps for Liver Health

The fetal protein index is elevated?

In September of this year, I underwent a comprehensive physical examination with the following results: GOT/31, GPT/61.8, R-GT/66, AFP/13.3.
Based on the report, I was advised to go to the hospital for further evaluation.
In early October, the blood test results from the hospital showed: GOT/24, GPT/54, R-GT/37, AFP/20.59.
Hepatitis C virus test: 0.77, HBs Ag: 0.386 (Nonreactive).
An ultrasound showed no abnormalities.
The CT scan findings are as follows:
Pre and post-contrast triphasic helical CT scanning of the liver and entire abdomen:
1.
There is no evidence of focal mass lesions in the hepatic parenchyma.
However, some radiopaque nodules were observed in hepatic segment S6, likely indicating calcification.

2.
General low attenuation in the hepatic parenchyma was noted on the non-contrast phase, suggestive of fatty liver.

3.
The portal system and spleen appeared intact.

4.
The parenchyma of other abdominal organs, including the appendix and bowel, showed no remarkable findings.

Impression:
1.
No evidence of hepatic focal mass lesions.

2.
Fatty liver.

3.
Hepatic calcifications.

In November, I returned for another blood test with results: GOT/20, GPT/37, AFP/18.62.
I would like to know if I should continue with further examinations or if I need to seek another hospital or different doctors for evaluation.

Y, 30~39 year old female. Ask Date: 2023/11/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to discuss further with the attending physician, including screening for testicular cancer.

Reply Date: 2023/11/26

More Info

Elevated levels of alpha-fetoprotein (AFP) can be a significant indicator of liver health, particularly in the context of liver disease or potential malignancies. Given your recent blood tests and imaging results, it is essential to understand the implications of these findings and the next steps you should consider for your liver health.

Firstly, your initial AFP level was 13.3, which is within the normal range, but it increased to 20.59 in the subsequent test. While this increase is not drastic, it is noteworthy and warrants further investigation, especially in conjunction with your liver function tests (GOT, GPT) and imaging results. The normal range for AFP is typically less than 10 ng/mL, but levels can vary based on the laboratory and the specific population being tested.

The imaging results you provided indicate that there are no focal mass lesions in the liver, which is reassuring. However, the presence of hepatic calcifications and fatty liver (steatosis) can be concerning. Fatty liver disease is often associated with metabolic syndrome, alcohol consumption, and certain medications, and it can lead to more severe liver conditions, including non-alcoholic steatohepatitis (NASH) and cirrhosis if not managed properly.

Given your situation, here are some recommended next steps:
1. Consult with a Hepatologist: If you haven't already, consider seeing a liver specialist (hepatologist) who can provide a more focused evaluation of your liver health. They can interpret your AFP levels in the context of your overall liver function and history.

2. Further Imaging Studies: Depending on the hepatologist's assessment, additional imaging studies such as an MRI or a more detailed ultrasound may be warranted to evaluate the liver's condition more thoroughly, especially to assess the fatty liver and any potential complications.

3. Lifestyle Modifications: If fatty liver is confirmed, lifestyle changes are crucial. This includes adopting a balanced diet low in saturated fats and sugars, increasing physical activity, and maintaining a healthy weight. These changes can significantly improve liver health and may help reduce liver fat.

4. Regular Monitoring: Regular follow-up blood tests to monitor liver function and AFP levels are essential. This will help track any changes over time and determine if further intervention is needed.

5. Screening for Viral Hepatitis: Since your tests for hepatitis B and C were non-reactive, it's good to continue monitoring for any signs of liver inflammation or damage. If there are any risk factors or symptoms, further testing may be necessary.

6. Consider Additional Tests: Depending on your risk factors and family history, your doctor may recommend additional tests, such as a liver biopsy or non-invasive tests like FibroScan, to assess liver stiffness and fibrosis.

In conclusion, while your initial findings do not indicate an immediate cause for alarm, the increase in AFP levels and the presence of fatty liver necessitate a proactive approach. Engaging with a healthcare provider who specializes in liver diseases will be crucial in determining the best course of action for your health. Regular monitoring, lifestyle changes, and potential further testing will help ensure that any issues are addressed promptly and effectively.

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