What are the main types of viral hepatitis. How do hepatitis A, B, and C differ in transmission and long-term effects. Who is at higher risk for contracting hepatitis viruses. When should you get tested for hepatitis.

What is Hepatitis and What Causes It?

Hepatitis refers to inflammation of the liver, which can be triggered by various factors including drug use, alcohol consumption, and certain medical conditions. However, the most common cause is viral infection, resulting in what’s known as viral hepatitis. The three primary forms of viral hepatitis are hepatitis A, B, and C.

While these viruses all affect the liver, they differ significantly in their modes of transmission, potential for chronic infection, and long-term health consequences. Understanding these differences is crucial for prevention, early detection, and appropriate management of hepatitis infections.

Recognizing the Symptoms of Hepatitis

The initial stages of hepatitis infection, known as the acute phase, may not always produce noticeable symptoms. However, when symptoms do appear, they can be similar across hepatitis A, B, and C:

• Fatigue
• Nausea
• Poor appetite
• Abdominal pain
• Mild fever
• Jaundice (yellowing of skin or eyes)

It’s important to note that chronic forms of hepatitis B and C may remain asymptomatic for years, potentially causing liver damage before any warning signs become apparent. This underscores the importance of regular screening for individuals at risk.

Can hepatitis symptoms vary in severity?

Yes, the severity of hepatitis symptoms can vary widely. Some individuals may experience mild, flu-like symptoms, while others may develop more severe manifestations. The type of hepatitis virus, the individual’s immune response, and overall health status can all influence symptom severity.

Hepatitis A: The Highly Contagious But Generally Mild Form

Hepatitis A stands out among the hepatitis viruses for its high contagiousness and typically mild course of infection. In many cases, infected individuals may not even realize they’ve contracted the virus due to its often subtle symptoms.

How does hepatitis A spread?

Hepatitis A primarily spreads through the fecal-oral route. This means that tiny amounts of feces from an infected person can contaminate food or water, leading to transmission when consumed by others. Common scenarios for transmission include:

• Consumption of raw or undercooked shellfish from contaminated waters
• Eating fruits, vegetables, or other foods handled by infected individuals who haven’t properly washed their hands
• Drinking contaminated water, especially in areas with poor sanitation
• Close personal contact in settings like daycare centers, where proper hygiene may be challenging to maintain

Who is at risk for hepatitis A?

While anyone can contract hepatitis A, certain groups face a higher risk:

• Travelers to countries with high hepatitis A rates
• Children attending daycare centers
• People living in areas with poor sanitation
• Men who have sex with men
• Users of recreational drugs

It’s worth noting that hepatitis A does not typically cause long-term liver damage and usually resolves on its own without chronic infection.

Hepatitis B: From Acute Infection to Chronic Condition

Hepatitis B presents a more complex picture than hepatitis A, with the potential for both acute and chronic infections. While many adults who contract hepatitis B experience only a short-term illness, some individuals, particularly those infected at a young age, may develop a lifelong chronic infection.

How is hepatitis B transmitted?

Hepatitis B spreads through contact with infected blood or body fluids. Common routes of transmission include:

• Unprotected sexual contact
• Sharing needles or other drug injection equipment
• From mother to child during childbirth
• Accidental needle sticks in healthcare settings
• Sharing personal items like razors or toothbrushes with an infected person

It’s important to understand that hepatitis B is not spread through casual contact such as hugging, sharing food, or coughing.

What are the long-term risks of chronic hepatitis B?

Chronic hepatitis B infection can lead to serious health complications over time, including:

• Liver cirrhosis (scarring)
• Liver failure
• Hepatocellular carcinoma (liver cancer)

These risks underscore the importance of early detection and appropriate management of hepatitis B infections.

Hepatitis C: The Silent Epidemic

Hepatitis C is often referred to as a “silent” epidemic due to its ability to cause long-term liver damage without producing noticeable symptoms for many years. Unlike hepatitis A and B, there is no vaccine available for hepatitis C, making prevention and early detection crucial.

How does hepatitis C spread?

Hepatitis C is primarily transmitted through blood-to-blood contact. The most common modes of transmission include:

• Sharing needles or other equipment for injecting drugs
• Receiving contaminated blood transfusions (primarily before 1992 when screening became routine)
• Using unsterilized equipment for tattoos or body piercings
• Mother-to-child transmission during childbirth (less common)
• Sexual transmission (rare, but possible, especially in the presence of HIV or rough sexual practices)

Why is hepatitis C often undiagnosed?

Many people with chronic hepatitis C remain undiagnosed because:

1. The infection often produces no symptoms for years or even decades
2. Some individuals may not realize they have risk factors (e.g., past drug use)
3. There’s a lack of routine screening for hepatitis C in many healthcare settings

This silent progression can lead to severe liver damage before the infection is discovered, highlighting the importance of risk-based and age-based screening recommendations.

Risk Factors and Populations of Concern

While anyone can potentially contract hepatitis, certain groups face a higher risk due to various factors. Understanding these risk factors is crucial for targeted prevention and screening efforts.

Who should be concerned about hepatitis B?

Groups at elevated risk for hepatitis B include:

• People with multiple sexual partners
• Men who have sex with men
• Injection drug users
• Healthcare workers exposed to blood
• People living with someone who has chronic hepatitis B
• Infants born to mothers with hepatitis B
• People from regions with high hepatitis B prevalence

Who is at higher risk for hepatitis C?

Key populations at risk for hepatitis C include:

• Anyone who has ever injected drugs, even once many years ago
• Recipients of blood transfusions or organ transplants before 1992
• People with HIV
• Healthcare workers exposed to needle sticks
• Children born to mothers with hepatitis C

Additionally, the U.S. Preventive Services Task Force recommends a one-time hepatitis C screening for all adults born between 1945 and 1965, as this age group has a higher prevalence of undiagnosed infections.

The Importance of Testing and Early Detection

Given the often asymptomatic nature of chronic hepatitis infections, testing plays a crucial role in identifying and managing these conditions before they lead to serious liver damage.

When should you get tested for hepatitis?

Consider hepatitis testing if you:

• Have any of the risk factors mentioned above
• Experience unexplained symptoms of liver disease
• Are pregnant (hepatitis B screening is routine in prenatal care)
• Were born between 1945 and 1965 (for hepatitis C)
• Are of Asian descent (due to higher hepatitis B prevalence)

Blood tests can determine whether you have a hepatitis infection and, if so, which type. Early detection allows for timely treatment and lifestyle modifications to prevent further liver damage.

How has hepatitis testing evolved?

Advancements in hepatitis testing have made screening more accessible and accurate. Modern tests can:

• Detect viral genetic material for precise diagnosis
• Measure viral load to guide treatment decisions
• Identify specific hepatitis virus genotypes
• Assess liver function to determine the extent of damage

These improved testing capabilities have significantly enhanced our ability to diagnose and manage hepatitis infections effectively.

Prevention Strategies for Hepatitis

While each type of hepatitis presents unique challenges, there are several strategies that can help prevent infection and transmission.

How can you protect yourself from hepatitis A?

To reduce your risk of hepatitis A:

• Get vaccinated, especially before traveling to high-risk areas
• Practice good hygiene, particularly handwashing after using the bathroom and before handling food
• Avoid consuming raw or undercooked shellfish
• Be cautious about drinking water and eating uncooked foods in areas with poor sanitation

What are effective prevention methods for hepatitis B?

To prevent hepatitis B infection:

• Get vaccinated – the hepatitis B vaccine is highly effective
• Practice safe sex by using condoms
• Avoid sharing needles, razors, or toothbrushes
• Ensure any tattoos or piercings are done with sterile equipment
• If you’re pregnant, get tested and ensure your baby receives appropriate prevention measures

How can you protect yourself from hepatitis C?

While there’s no vaccine for hepatitis C, you can reduce your risk by:

• Never sharing needles or other drug injection equipment
• Ensuring any tattoos or piercings are done in licensed facilities with sterile equipment
• Practicing safe sex, especially if you have multiple partners or HIV
• Avoiding shared personal items that might have blood on them (razors, toothbrushes)
• If you’re a healthcare worker, following safety protocols to prevent needle sticks

By understanding the different types of hepatitis, their transmission routes, and prevention strategies, individuals can take proactive steps to protect their liver health and overall well-being. Regular screening for those at risk, combined with vaccination where available, can significantly reduce the impact of these viral infections on public health.

A Visual Guide to Hepatitis A, B, C

Medically Reviewed by Gabriela Pichardo, MD on September 05, 2021

Hepatitis is an inflammation of the liver. It may be caused by drugs, alcohol use, or certain medical conditions. But in most cases, it’s caused by a virus. This is known as viral hepatitis, and the most common forms are hepatitis A, B, and C.

Sometimes there are no symptoms of hepatitis in the first weeks after infection — the acute phase. But when they happen, the symptoms of types A, B, and C may include fatigue, nausea, poor appetite, belly pain, a mild fever, or yellow skin or eyes (jaundice). When hepatitis B and C become chronic, they may cause no symptoms for years. By the time there are any warning signs, the liver may already be damaged.

Hepatitis A is highly contagious and can spread from person to person in many different settings. It typically causes only a mild illness, and many people who are infected may never realize they’re sick at all. The virus almost always goes away on its own and does not cause long-term liver damage.

It usually spreads through food or water. Food can be tainted when it’s touched by a person with hepatitis who did not wash their hands after using the bathroom. This transfers tiny amounts of infected stool to the food. Raw shellfish, fruits, vegetables, and undercooked foods are common culprits in hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren’t careful about washing hands after changing diapers.

A prime risk factor for hepatitis A is traveling to or living in a country with high infection rates. You can check the CDC’s travel advisories to learn about recent outbreaks. Eating raw foods or drinking tap water can raise your risk while traveling. Children who attend daycare centers also have a higher risk of getting hepatitis A.

Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.

You can get it through contact with the blood or body fluids of an infected person. In the U.S., it’s most often spread through unprotected sex. It’s also possible to get hepatitis B by sharing an infected person’s needles, razors, or toothbrush. And an infected mother can pass the virus to their baby during childbirth. Hepatitis B is not spread by hugging, sharing food, or coughing.

Anyone can get hepatitis B, but people who have multiple sex partners or inject illegal drugs have a higher risk. Other risk factors include being a health care worker who is exposed to blood, or living with someone who has chronic hepatitis B.

About 25% of people who get hepatitis C defeat the virus after a short-term infection. The rest will carry the virus in their body for the long term. Chronic hepatitis C can cause very serious complications, including liver failure and liver cancer. There are effective treatments for the virus, though. 

It spreads through infected blood. In the U.S., sharing needles or other items used to inject drugs is the most common cause of infection. Getting a tattoo or body piercing with an infected needle is another means of exposure. A mother may pass the virus to their child at birth. In rare cases, unprotected sex spreads hepatitis C, but the risk appears small. Having multiple sex partners, HIV, or rough sex seems to raise risk for spreading hepatitis C.

People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.

Chronic hepatitis can quietly attack the liver for years without causing any symptoms. Unless the infection is diagnosed, monitored, and treated, many of these people will eventually have serious liver damage. Fortunately, blood tests can determine whether you have viral hepatitis, and if so, which kind.

Testing is important for anyone with the risk factors we’ve mentioned, particularly injected drug users and people who have had multiple sex partners. Health advocates are also urging people of Asian heritage to get tested. Stanford University’s Asian Liver Center estimates that 1 in 10 Asians living in the U.S. has chronic hepatitis B. Many of them have probably had the virus since birth.

Also, the U.S. Preventive Services Task Force recommends that health care providers offer a one-time hepatitis C screening for anyone born between 1945 and 1965.   

If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.

Hepatitis A almost always goes away on its own, and no medication is needed. If nausea is a problem, try eating several small meals throughout the day instead of three large ones. Drink water, juice, or sports drinks to stay hydrated. And avoid hard exercise until you’re feeling better.

The goal of treating chronic hepatitis B is to control the virus and keep it from damaging the liver. This begins with regular monitoring for signs of liver disease. Antiviral medications may help, but not everyone can take them or needs to be on medication. Be sure to discuss the risks and benefits of antiviral therapy with your doctor.

The latest drug to be approved by the FDA is glecaprevir and pibrentasvir (Mavyret). This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.

There are several other combination drugs available, as well as some single drugs that may be used in combination. Your doctor will choose the right one for you depending on the type of hepatitis C you have, how well your liver is functioning and any other medical problems you may have. Also be sure to discuss your insurance coverage since these medications are expensive.

To manage chronic hepatitis B or C, your doctor will order regular blood tests to check how well your liver is working. Ultrasounds and CT scans can also reveal signs of damage. If the virus is not causing any liver problems, you may not need treatment. But it’s important to have regular tests to watch for changes. Complications are easiest to treat when found early.

One of the most common complications of chronic hepatitis is cirrhosis. This is a scarring of the liver that can be found with a biopsy. Cirrhosis makes it difficult for the liver to do its job and can lead to liver failure, a life-threatening condition. Symptoms include fatigue, nausea, weight loss, and swelling in the belly and legs. In severe cases, patients may experience jaundice and confusion.

Viral hepatitis is the top cause of liver cancer, so people with chronic hepatitis B or C need monitoring even if they feel healthy. Blood tests can detect proteins that suggest the presence of liver cancer. Ultrasounds, CT scans, and MRIs can reveal abnormal lesions in the liver (seen here in green). A biopsy is needed to determine if these areas are cancerous. Tumors that are found early may be surgically removed. But most liver cancers are difficult to treat.

The liver is a vital organ that aids in metabolism, digestion, detoxifying, and the production of many proteins needed by the body. If a large part of the liver is damaged beyond repair, it will no longer be able to perform these important jobs. People cannot live without a working liver. In this case, a liver transplant may be the best hope. This option provides the patient with a healthy liver from a donor.

There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.

If you have chronic hepatitis, there are steps you can take to keep your liver resilient. Avoid alcohol, which can cause additional liver damage. Check with your doctor before taking any medications or supplements, because some are tough on the liver or may not be safe in people with liver disease. Most importantly, keep your appointments for regular monitoring. By watching for any changes in your liver, you and your health care provider can stay one step ahead of the virus.

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 23)   Image Source

SOURCES:

Allegheny General Hospital Liver Cancer Network.
American Cancer Society web site.
American Liver Foundation web site.
Centers for Disease Control and Prevention web site.
Hepatitis Foundation web site.
John W. Ward, MD, director, division of viral hepatitis, CDC, Atlanta.
Melissa Palmer, MD, clinical professor of medicine, New York University School of Medicine, New York City.
National Digestive Diseases Information Clearinghouse.
Pediatrics, published online Feb. 1, 2011.
The Nemours Foundation.
World Health Organization web site.
FDA. “FDA approves Mavyret for Hepatitis C.” “Mavyret Prescribing Information.”
Hepatitis C Online. “Hepatitis C Treatments.”

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Vitamin A (Retinoid) Benefits for Vision and Health

Written by R. Morgan Griffin

Medically Reviewed by Jennifer Robinson, MD on May 02, 2023

• Why do people take vitamin A?
• How much vitamin A should you take?
• Can you get vitamin A naturally from foods?
• What are the risks of taking vitamin A?

Vitamin A is key for good vision, a healthy immune system, and cell growth. There are two types of vitamin A. This entry is primarily about the active form of vitamin A — retinoids — that comes from animal products. Beta-carotene is among the second type of vitamin A, which comes from plants.

The American Heart Association recommends obtaining antioxidants, including beta-carotene, by eating a well-balanced diet high in fruits, vegetables, and whole grains rather than from supplements until more is known about the risks and benefits of supplementation.

High doses of antioxidants (including vitamin A) may actually do more harm than good. Vitamin A supplementation alone, or in combination with other antioxidants, is associated with an increased risk of mortality from all causes, according to an analysis of multiple studies.

Topical and oral retinoids are common prescription treatments for acne and other skin conditions, including wrinkles. Oral vitamin A is also used as a treatment for measles and dry eye in people with low levels of vitamin A. Vitamin A is also used for a specific type of leukemia.

Vitamin A has been studied as a treatment for many other conditions, including cancers, cataracts, and HIV. However, the results are inconclusive.

Most people get enough vitamin A from their diets. However, a doctor might suggest vitamin A supplements to people who have vitamin A deficiencies. People most likely to have vitamin A deficiency are those with diseases (such as digestive disorders) or very poor diets.

The recommended dietary allowance (RDA) includes the vitamin A you get from both the food you eat and any supplements you take.

The tolerable upper intake levels of a supplement are the highest amount that most people can take safely. Higher doses might be used to treat vitamin A deficiencies. But you should never take more unless a doctor says so.

* There is no upper limit for vitamin A from beta-carotene.

Getting enough vitamin A can easily be obtained through a healthy diet.

Good food sources of retinoid vitamin A include:

• Eggs
• Whole milk
• Liver
• Fortified skim milk and cereals

Plant sources of vitamin A (from beta-carotene) include sweet potatoes, carrots, spinach, and apricots.

• Side effects. Symptoms of vitamin A toxicity include dry skin, joint pain, vomiting, headaches, confusion.
• Interactions. If you take any medicines, ask your doctor if vitamin A supplements are safe. Vitamin A supplements may interact with some birth control pills, some blood thinners,  some oral acne medicines, cancer treatments, and many other drugs.
• Risks. Don’t take more than the RDA of vitamin A unless your doctor recommends it. High doses of vitamin A have been associated with birth defects, lower bone density, and liver problems. People who drink heavily or have kidney or liver disease shouldn’t take vitamin A supplements without talking to a doctor.

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The norm of ALT and AST levels in a blood test in women: what you need to know?

Contents

• 1 ALT and AST norms in women’s blood tests
  • 1. 1 Women’s blood tests
  • 1.2 What are ALT and AST?
  • 1.3 The value of ALT and AST in the blood test
  • 1.4 Normal levels of ALT and AST in women
  • 1.5 The effect of age on the level of ALT and AST
  • 1.6 Causes of elevated levels of ALT and AST
  • 1.7 Liver disease and ALT and AST levels
  • 1.8 Cardiovascular disease and ALT and AST levels
  • 1.9 Causes of low ALT and AST levels
  • 1.10 Liver disease and low ALT and AST levels
  • 1.11 Vitamin deficiency and low ALT and AST levels
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What are ALT and AST?
      • 1.13.0.2 Why do I need to measure blood levels of ALT and AST?
      • 1.13.0.3 What are the ALT and AST norms for women?

The norm of the level of ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in the blood test in women. What values ​​are considered normal and what may indicate deviations from the norm. Important indicators for diagnosing the condition of the liver and heart.

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes that are found inside liver and heart cells. They play an important role in the metabolism of amino acids and are involved in the process of energy formation. The study of the levels of ALT and AST in the blood test reveals the presence and extent of damage to these organs.

Normal values ​​of ALT and AST are somewhat different in men and women, due to differences in body physiology. On average, in women, the acceptable level of ALT is from 7 to 35 units per liter, and the level of AST is from 7 to 31 units per liter of blood.

Elevated levels of ALT and AST may be indicative of various diseases and conditions. For example, elevated ALT levels may be associated with liver disease such as hepatitis or cirrhosis, and AST levels may be elevated with myocardial infarction or heart failure. However, elevated values ​​of these enzymes can also indicate other problems in the body, so diagnosis always requires an integrated approach and additional research.

Blood test for women

Blood test is one of the most common and informative laboratory procedures for assessing women’s health. It allows you to identify various deviations and pathologies, as well as monitor the effectiveness of treatment.

Normal blood levels of ALT and AST in women depend on age and health status. Typically, ALT levels do not exceed 31 U/L and AST levels do not exceed 35 U/L. However, it must be taken into account that these indicators may vary depending on the laboratory and the research method.

Elevated levels of ALT and AST in a woman’s blood test can be due to various causes, including liver disease (hepatitis, cirrhosis), heart disease (heart attack, angina pectoris), as well as the use of certain drugs or an alcohol disorder.

For women, regular blood testing is an important tool for maintaining health and preventing serious illness. In case of detection of deviations in the levels of ALT and AST, it is necessary to consult a doctor for additional studies and diagnosis.

What are ALT and AST?

ALT and AST are shorthand for enzymes called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). They are present inside the cells of organs, especially in the liver, heart, muscles and kidneys. Blood levels of ALT and AST can be used to assess the function of these organs.

ALT and AST are enzymes that play a key role in amino acid metabolism in the body. ALT is responsible for the transfer of the amino group from alanine to alpha-ketoglutarate, and AST from aspartate to alpha-ketoglutarate. These enzymes are an integral part of the process of amino acid metabolism and energy metabolism in the body.

ALT and AST are located inside the cells of the organs and usually they hardly penetrate into the blood. However, when cells are damaged, the levels of these enzymes can increase and enter the bloodstream. Elevated ALT levels may indicate liver damage, while elevated AST levels may indicate damage to the liver, heart, or muscles.

ALT and AST value in the blood test

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes that are found inside the cells of organs, especially the liver and heart. When cell integrity is compromised, these enzymes are released into the blood.

ALT and AST can be used to determine the presence or extent of organ damage. Usually, their levels are markedly increased in the presence of liver diseases such as hepatitis or cirrhosis, as well as in heart disease and muscle damage.

In general, normal levels of ALT and AST in a blood test for women may be as follows:

• ALT: 7-35 U/L
• AST: 10-30 U/L used in the laboratory, therefore, when interpreting the results, it is necessary to take into account the recommendations of the doctor.

  If the levels of ALT and AST in the blood test exceed the norm, this may indicate the presence of a pathological process in the liver, heart or other organs. In this case, the doctor may prescribe additional studies to determine the cause of the increase in these enzymes.

  Normal levels of ALT and AST in women

  ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes that are found inside the cells of various organs, including the liver, heart, muscles, kidneys and others. The level of these enzymes in the blood can indicate the condition of these organs.

  Normal ALT levels in women vary by test and lab, but typically range from 7 to 35 units per litre. Elevated ALT levels can indicate various liver problems such as hepatitis, cirrhosis, or other diseases.

  Normal AST levels in women can also vary by assay, but are typically between 5 and 40 units per litre. Elevated AST levels can indicate a variety of problems, including heart and muscle disease, and liver or kidney damage.

  If ALT and AST levels in a woman’s blood are higher than normal, it is recommended to see a doctor for an examination and find out the cause. Diagnosis of the underlying disease that caused the increase in ALT and AST levels will allow prescribing effective treatment and preventing possible complications.

  Effect of age on ALT and AST levels

  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) blood levels in women may vary with age. With age, there is often a gradual increase in the levels of these enzymes.

  ALT and AST levels can also be affected by age due to the presence of various diseases that can occur with age. Some diseases, such as cirrhosis of the liver, hepatitis, cholecystitis and other pathologies of the biliary tract, can lead to an increase in the level of ALT and AST.

  It should be noted that the level of ALT and AST may vary depending on the individual characteristics of the woman. Therefore, when analyzing blood, it is necessary to take into account age, general condition of the body and other factors that can affect the level of these enzymes.

  Causes of elevated levels of ALT and AST

  Elevated levels of ALT and AST in the blood test in women can be caused by various reasons. This may be due to damage to cells in the liver, heart, muscles, or other organs.

  One of the most common causes of elevated ALT and AST levels is liver disease such as cirrhosis or hepatitis. In these diseases, liver cells are damaged and the level of ALT and AST in the blood increases significantly.

  Also elevated levels of ALT and AST can be caused by heart problems such as myocardial infarction or heart failure. When the heart muscle is damaged, more ALT and AST are released, which leads to their increase in the blood.

  Other causes of elevated ALT and AST levels include the use of certain drugs, alcohol or drug poisoning, mechanical damage to organs or muscles, infectious diseases, and certain genetic disorders.

  It is important to note that elevated levels of ALT and AST do not always indicate a serious problem and may be temporary or caused by minor causes. However, if elevated levels of ALT and AST persist, it is necessary to consult a doctor for further examination and clarification of the cause.

  Liver disease and ALT and AST levels

  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes that are found in high concentrations in liver cells. With the development of various liver diseases, such as hepatitis, cirrhosis, fatty degeneration, and others, the levels of ALT and AST can increase significantly.

  However, an increase in ALT and AST may not always indicate the presence of a disease. The levels of these enzymes can also be elevated in the event of injury, certain medications, strenuous exercise, and even after drinking alcohol.

  To determine the state of the liver and diagnose possible diseases, in addition to ALT and AST levels, a comprehensive blood test is usually performed, including the assessment of other indicators, such as levels of bilirubin, gamma-glutamyl transferase (GGT), alkaline phosphatase, and the diagnostic role of which is also very important.

  When ALT and AST levels are abnormal, your doctor may recommend additional tests such as liver ultrasound, Liverscan, liver biopsy, and others. It is important to remember that it is impossible to draw final conclusions about the state of the liver only by the levels of ALT and AST, a comprehensive assessment of all indicators and a medical opinion are required.

  Therefore, if you have elevated levels of ALT and AST, do not panic, see a doctor who can diagnose and identify the cause of such changes. Medical care and timely access to a doctor play an important role in assessing the condition of the liver and preventing possible complications.

  Cardiovascular disease and ALT and AST levels

  Cardiovascular disease is one of the leading causes of death among women worldwide. Often these diseases do not have pronounced symptoms in the early stages, so it is important to regularly monitor your health and conduct tests, including ALT and AST levels.

  ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes found in various organs, including the liver and heart. If these organs are damaged, the levels of ALT and AST can increase significantly, indicating the presence of pathological processes.

  The level of ALT in a blood test is an indicator of liver function. With defects and damage to the liver cells, such as cirrhosis or hepatitis, ALT may increase. In addition, elevated levels of ALT may indicate the presence of heart failure, which often develops against the background of cardiovascular disease.

  At the same time, AST levels can also be an indicator of heart disease. An increase in AST may indicate the presence of myocardial infarction or acute coronary syndrome. However, a simple increase in the level of AST is not a specific indicator of cardiovascular disease, so additional examination is required to clarify the diagnosis.

  Thus, the control of ALT and AST levels in the blood test is an important step in the diagnosis of cardiovascular disease in women. Elevated values ​​of these enzymes may indicate the presence of a pathology, however, an integrated approach and additional examination are required to make an accurate diagnosis and prescribe treatment.

  Causes of low levels of ALT and AST

  Low levels of ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in the blood test can indicate various diseases and conditions in the body of women.

  1. Liver failure: Low levels of ALT and AST may indicate serious liver problems. This may be due to cirrhosis of the liver, chronic hepatitis, hepatic necrosis, or other liver pathologies.

  2. Heart disease: Low AST levels may be associated with heart disease such as myocardial infarction, heart failure, or arrhythmias. This is due to the fact that AST is contained in the mitochondria of the heart muscle and its decrease may indicate damage to the heart tissue.

  3. Vitamin deficiency: Low levels of ALT and AST may be due to a lack of important vitamins such as vitamin B6 and vitamin B12. Deficiency of these vitamins can cause abnormalities in the functioning of the liver and heart, which leads to a decrease in the levels of ALT and AST in the blood.

  4. Individual features: Some women have low levels of ALT and AST in the blood up to the physiological norm. This may be due to the peculiarities of their metabolism or genetic factors. In such cases, low levels of ALT and AST are usually not dangerous and do not require additional examination or treatment.

  It is important to note that low levels of ALT and AST in the blood test require further investigation and consultation with a physician. Only he can determine the specific cause of such changes and prescribe the necessary treatment or observation.

  Liver disease and low ALT and AST levels

  ALT (alanine aminotransferase) and AST (aspartate aminotransferase) blood values ​​are important indicators of liver function. They help determine the presence or absence of damage to the organ. In some liver diseases, however, ALT and AST levels may be low or normal, which can be difficult to diagnose.

  One cause of low ALT and AST may be liver atrophy. With this disease, the volume of the liver decreases, which leads to a decrease in the activity of enzymes. Another possible cause of low levels of ALT and AST is cirrhosis of the liver, which is characterized by the replacement of healthy organ tissue with scarring. In this case, the number of liver cells that produce ALT and AST decreases, which leads to low levels of these enzymes in the blood.

  In addition to atrophy and cirrhosis of the liver, low levels of ALT and AST may be associated with the presence of diseases for the first time that can suppress the functioning of the organ. These diseases include hepatitis and fatty degeneration of the liver. In these pathologies, inflammation and accumulation of lipids in the liver are present, which leads to a decrease in the activity of ALT and AST. This, in turn, may indicate the presence of a progression of the disease or a reactive state of the body.

  It is important to note that low levels of ALT and AST are not specific signs of specific liver diseases and may be symptoms of various pathologies. Additional studies and analyzes are needed for an accurate diagnosis. The results of the blood test should be interpreted in the light of other clinical findings and in consultation with the physician.

  Vitamin deficiency and low levels of ALT and AST

  A significant decrease in the levels of ALT and AST in the blood test in women may be associated with a vitamin deficiency. Vitamins are important trace elements necessary for the normal functioning of the body. They are catalysts for many biochemical reactions, including those that regulate ALT and AST levels.

  Deficiency of certain vitamins can lead to decreased activity of these enzymes. For example, a lack of vitamin B6 may be associated with low levels of ALT and AST. Vitamin B6 plays an important role in the metabolism of amino acids, which form the basis of proteins, including ALT and AST.

  Vitamin C deficiency may also be associated with low levels of ALT and AST. Vitamin C is involved in the synthesis of collagen, which strengthens the walls of blood vessels. Its deficiency can lead to liver damage and lower ALT and AST levels.

  In general, low ALT and AST levels associated with vitamin deficiencies can indicate organ and system dysfunction. You need to pay attention to your diet and ensure that you are getting enough of all the essential vitamins to maintain normal ALT and AST levels and overall body health.

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  Q&A:

  What are ALT and AST?

  ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes found in the cells of the liver, heart, muscles and other organs. They specifically process certain amino acids and help in converting them into energy for the body to work.

  Why should ALT and AST levels be measured?

  Blood ALT and AST levels can be used to evaluate the condition of the liver and other organs such as the heart and muscles. Elevated levels of these enzymes may indicate the presence of inflammation or damage to the cells in these organs.

  What are the ALT and AST norms for women?

  Normal blood levels of ALT and AST may vary slightly between laboratories depending on the methods used. In general, normal ALT levels usually do not exceed 30 U/L and AST levels do not exceed 34 U/L. However, for an accurate interpretation of the results, it is best to consult a doctor who knows the patient’s history and can take into account other factors.

  preparation, table of normal values, interpretation

  Biochemical blood test is a detailed study of the patient’s venous blood, conducted to assess the functioning of internal organs, identify deficiency of vitamins, enzymes, macro- and microelements, as well as to diagnose metabolic pathology. Blood biochemistry is more indicative than a general clinical analysis; the results of the analysis make it possible to detect many diseases at an early stage. That is why this study is recommended to be carried out not only as prescribed by a doctor, but also for preventive purposes at least once a year. The results of a biochemical blood test include many interconnected indicators and a doctor should be involved in their interpretation – self-medication is dangerous for your health!

  How to prepare for the procedure?

  • Blood sampling for biochemistry is always performed on an empty stomach, most often between 8 and 11 am. On the day of the procedure, non-carbonated water is allowed, and the day before the procedure, heavy food, carbonated drinks, strong coffee, tea and alcohol should be excluded from the diet.
  • Do not smoke during the last hour before donating blood.
  • Immediately before the procedure, try to avoid physical and emotional stress, the last 10-20 minutes it is better to just sit near the manipulation room.
  • If the date of the biochemical blood test falls on the period of taking a course of drug treatment or a course of physiotherapy, then it is worth consulting with your doctor – he may recommend rescheduling the study to another time or interrupting the course of treatment for several days.

  Interpretation of chemistry results

  The new generation of laboratory analyzers can provide test results within two hours of blood sampling. As a rule, the patient receives the results within 2-3 days in the form of a printed or electronic table, which lists the studied indicators, their values ​​and reference (average) normal ranges. Different laboratories offer different amounts of data, in the same article the most commonly studied blood parameters will be described.

  Proteins

  	Designation	Norma (women)	Norma (men)	Units
  Albumin	ALB	< 14 years: 38-54 14-60 years: 35-50 > 60 years: 34-38		g/l
  Glycated hemoglobin	HbA1c, A1c, glycosylated hemoglobin	< 5.7		%
  Total protein	TP, TProt, Serum	< 1 year: 47-72 1-4 years: 61-75 5-7 years: 52-78 8-15 years: 58-76 > 15 years: 64-83		g/l
  C-reactive protein	CRP, SRP	< 0. 5		g/l
  Serum iron binding capacity	TIBC, IBC, OJSS	45.3–77.1		µmol/l
  Myoglobin	Myoglobin	12-76	19-92	µg/l
  Transferrin	Tf	2.2-2.4	2-4	g/l
  Ferritin	Ferritin	13–150	30–400	µg/l

  Total protein characterizes the state of protein metabolism and reveals dysproteinemia (change in the quantitative ratio of protein fractions in blood serum). Decreased values ​​may indicate malnutrition, liver disease, burns, trauma, and surgery, while elevated values ​​may indicate an infectious disease, non-infectious hepatitis, autoimmune disease, dehydration, or may be caused by diarrhea and vomiting.

  Protein albumin occupies up to 65% of the blood plasma volume, is produced by the liver and performs the most important function of transporting many biologically active substances. The reasons for the decrease in albumin concentration coincide with those for the total protein. The value increases quite rarely, for example, with dehydration, hemoconcentration, or as a result of taking anabolic steroids.

  The iron-containing protein myoglobin is being investigated primarily for the early diagnosis of myocardial infarction. A high concentration of myoglobin may indicate myocardial infarction, heart failure, acute kidney injury, the effects of thermal burns, electric shock. Low myoglobin accompanies the course of rheumatoid arthritis and poliomyelitis.

  The value of glycated or glycosylated hemoglobin is very important for patients with diabetes mellitus, and is also used for its diagnosis. Glycated hemoglobin gives an idea of ​​the average level of glucose in the blood over a long period of time (1–2 months). If the concentration of this protein fraction does not exceed 5.7% of the total volume of hemoglobin in the blood, then we can speak of a compensated state. Values ​​in the range of 5.7–6.4% indicate a risk of developing diabetes mellitus, above 6.4% indicate severe decompensated diabetes.

  C-reactive protein acts as an indicator of the inflammatory process in the body. Exceeding the threshold of 0.5 g/l indicates acute inflammation or malignancy. Also, this parameter is important for evaluating the effectiveness of antibacterial and anti-inflammatory therapy.

  The studied values ​​of transferrin , ferritin and iron-binding capacity of serum allow diagnosing the pathology of iron metabolism in the blood. Transferrin is the main carrier of iron, an increase in its concentration, as a rule, indicates the development of iron deficiency anemia, and a decrease indicates infections, cirrhosis of the liver, anemia of a different etiology, or protein starvation. With iron deficiency anemia, ferritin, on the contrary, decreases, and its increase indicates inflammatory processes, liver disease, or oncopathology.

  Lipids

  	Designation	Norma (women)	Norma (men)	Units
  Triglycerides	TRIG	< 15 years old: 0.40–1.48 15–30 years old: 0.4–1.63 30–55 years old: 0.44–2.63 > 55 years old: 0.62–2.71	< 15 years old: 0.34-1.41 15-30 years old: 0.45-2.81 30-55 years old: 0.56-3.61 > 55 years old: 0.65-3.29	mmol/l
  Total cholesterol	CHOL	5.2		mmol/l
  HDL cholesterol	HDL, HDL-C	1.03–1.55		mmol/l
  LDL cholesterol	LDL, LDL-C	0–3.3		mmol/l

  Total cholesterol is used to detect primary and secondary disorders of lipid metabolism, assess the likelihood of atherosclerosis, and also to evaluate the effectiveness of the treatment of atherogenic disorders of lipid metabolism. A decrease in the value is caused by cachexia, starvation, malabsorption, severe acute diseases, liver failure, hyperthyroidism, and an increase is caused by primary and secondary dyslipoproteinemia. Dangerous consequences of low cholesterol are psychophysiological disorders and reproductive dysfunction, high – diabetes mellitus and atherosclerosis. Biochemical blood test for triglycerides (products of carbohydrate metabolism in the liver) pursues the same tasks, the reasons for the increase and decrease in their concentration also coincide with total cholesterol.

  High density lipoprotein cholesterol and low density lipoprotein (HDL-C and LDL-C respectively) are examined and interpreted in combination with total cholesterol and triglycerides for a more accurate diagnosis. HDL-C increases with primary biliary cirrhosis, hepatitis, alcoholism, or its increase may be genetically determined. In patients with atherosclerosis, decompensated diabetes mellitus, chronic kidney disease, cholestasis, the value of HDL-C decreases. Low-density lipoproteins are involved in the processing and excretion of fats, a decrease in their concentration may indicate the development of chronic anemia, Raynaud’s syndrome or myeloma, and an increase in hypothyroidism, nephrotic syndrome, diabetes mellitus, porphyria, Cushing’s syndrome, the risk of atherosclerosis.

  Carbohydrates

  	Designation	Norma (women)	Norma (men)	Units
  Glucose	GLUC	3.3-5.5		mmol/l
  Fructosamine	FRA	0–285		µmol/l

  Glucose is the main source of energy for all cells and tissues of the human body and, in particular, its only source for the brain. The value of glucose in the results of biochemical analysis reflects the level of sugar in the blood. If this value is increased, then there is a risk of developing diabetes mellitus, damage to the central nervous system, and hormonal disorders. Glucose “falls” with the formation of tumors in the pancreas, with liver and adrenal insufficiency, hypothyroidism, malnutrition, or due to insulin intake.

  The value of fructosamine reflects the fluctuation in blood glucose levels during the 2-3 weeks prior to the test. If its concentration exceeds 280–285 µmol / l, then the doctor considers the likelihood of developing diabetes.

  Inorganic substances and vitamins

  	Designation	Norma (women)	Norma (men)	Units
  Vitamin B12		208-963.5		pg/ml
  Iron	Fe, IRON	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 9-30	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 11-31	µmol/l
  Potassium	K	3.5–5		mmol/l
  Calcium	Ca	2. 25-2.5		mmol/l
  Magnesium	Mg	0.75–1.25		mmol/l
  Sodium	Na	136-145		mmol/l
  Phosphorus	P	< 2 years: 1.45-2.16 2-12 years: 1.45-1.78 12-60 years: 0.87-1.45 > 60 years: 0.90-1.32	< 2 years: 1.45–2.16 2–12 years: 1.45–1.78 12–60 years: 0.87–1.45 > 60 years: 0.74–1.2	mmol/l
  Chlorine	Cl	98-107		mmol/l

  Vitamin B12 in the human body is involved, in particular, in the production of red blood cells. High levels of this vitamin can indicate liver disease, kidney disease, or leukemia. Diseases of parasitic etiology, inflammatory processes in the gastrointestinal tract and adherence to a vegetarian (vegan) diet, on the contrary, lead to a decrease in the level of vitamin B12 in the blood.

  In one of the previous paragraphs it was mentioned that iron takes part in the process of transporting oxygen. Its deficiency is usually explained by malnutrition or metabolic disorders, and its excess – by functional disorders of the intestine.

  Potassium is responsible for the regulation of water balance and normalizes the heart rhythm. Potassium deficiency occurs due to malnutrition or malnutrition, vomiting, renal failure, Cushing’s syndrome, osmotic diuresis, chronic kidney disease, and also accompanies long-term use of steroid drugs. Potassium also increases with acute dehydration, extensive injuries and burns, chronic adrenal insufficiency, diabetic coma, or as a result of taking potassium-sparing diuretics.

  Calcium is involved in the formation of bone tissue, it is extremely important for the normal functioning of muscles, nerves, heart muscle and blood vessels. Low blood calcium values ​​indicate vitamin D deficiency, functional kidney disease, pancreatitis, impaired magnesium metabolism, or hypoparathyroidism. An increase in calcium levels accompanies hyperparathyroidism or is a symptom of oncopathology.

  Magnesium performs the function of intracellular metabolism and transmission of impulses from nerve endings to muscles. Malnutrition, malabsorption, prolonged diarrhea, colitis, enterocolitis and dyspepsia reduce the concentration of magnesium in the blood. Functional disorders of the kidneys, hypothyroidism, lactic acidosis and neoplasms lead to its increase.

  Along with magnesium, sodium , also involved in calcium metabolism, is responsible for the transmission of impulses to the muscles. The reason for the decrease in sodium can be hypothyroidism, Addison’s disease, diabetes mellitus, kidney and gastrointestinal tract diseases, congestive heart failure, taking gentamicin, less often – Parkon’s syndrome or hypercalciuria. High levels of sodium in the results of biochemistry indicate dehydration, oversaturation of the body with salts, diabetes insipidus or kidney disease with oliguria.

  Normal functioning of the nervous and musculoskeletal systems is impossible without a sufficient amount of phosphorus in the body. The content of phosphorus in the blood increases with hypoparathyroidism, an excess of vitamin D, rhabdomyolysis, bone diseases or improper diet, less often with acromegaly. On the other hand, hypovitaminosis D, hyperparathyroidism, kidney transplantation, intravenous glucose infusions, respiratory alkalosis cause a decrease in the concentration of phosphorus in the blood.

  Chlorine performs the functions of maintaining the acid-base balance of the blood and osmotic pressure. The most obvious causes of a decrease in chlorine levels are profuse sweating, vomiting, diarrhea, incorrect treatment with diuretics, less commonly, a decrease is caused by nephrotic syndrome and hypokalemic metabolic syndrome. An excess of chlorine in the blood can be a consequence of dehydration, swelling, alkalosis and decompensation of cardiac activity.

  Example of blood chemistry results

  Low molecular weight nitrogenous substances

  	Designation	Norma (women)	Norma (men)	Units
  Creatinine	CREA	53–97	62-115	µmol/l
  Uric acid	UA	< 14 years: 120-320 > 14 years: 150-350	< 14 years old: 120-320 > 14 years old: 210-420	µmol/l
  Urea	UREA	2.2–6.7	3.8–7.3	mmol/l

  Urea and creatinine are studied in combination, their values ​​reflect the functional state of the patient’s kidneys, in particular, the degree of impairment of filtration and excretory functions. High values ​​indicate kidney problems, but may be due to excessive exercise, a high-protein diet, prolonged fasting, or thyroid disease. Low urea values ​​may be due to a low protein diet, pregnancy, and liver disease.

  The level of uric acid as an auxiliary parameter reflects the body’s ability to remove waste products from the processes of nucleic acid and purine metabolism. It is of particular diagnostic interest in patients with gout. The main causes of increased uric acid are gout and alcoholism, less often – the pathology of the kidneys and liver. Low values ​​of uric acid in the results of a biochemical blood test are much less common and usually indicate malnutrition or malnutrition.

  Pigments

  	Designation	Norma (women)	Norma (men)	Units
  Total bilirubin	BILT	3.4-17.1		µmol/l
  Direct bilirubin	BILD, D-BIL	0–7.9		µmol/l
  Bilirubin indirect	ID-BIL	BILT – BILD		µmol/l

  Yellow pigment bilirubin begins to accumulate in the blood in diseases and hereditary pathologies of the liver, biliary tract, for example, Gilbert’s syndrome. Indirect bilirubin can also be elevated in some anemias and malaria.

  Enzymes

  	Designation	Norma (women)	Norma (men)	Units
  Alanine aminotransferase	ALT	< 31	< 41	units/l
  Amylase	AMY	28–100		units/l
  Pancreatic amylase	AMY-P	0–50		units/l
  Aspartate aminotransferase	AST	< 32	< 40	units/l
  Gamma-glutamyltransferase	GGT	6-42	10–71	units/l
  Creatine kinase	CK	0–25		units/l
  Lactate dehydrogenase	LDH	250		units/l
  Lipase	LIP	0–190		units/l
  Alkaline phosphatase	ALP	0–240	0–270	units/l
  Cholinesterase	CH	5860–11800	5800–14600	units/l

  Liver enzyme with an unpronounceable name alanine aminotransferase is involved in amino acid metabolism. The indicator increases with myocardial infarction, acute hepatitis A and B, and other liver diseases.

  Enzyme amylase is produced by the salivary glands and pancreas and is responsible for the digestion of carbohydrates. Exceeding the norm by 3-5 times may indicate acute appendicitis, peritonitis, stomach and duodenal ulcers, cholecystitis. In acute pancreatitis or exacerbation of its chronic form, the value of amylase increases by 10–30 times. An increased value of pancreatic amylase allows timely detection of complications of operations on the abdominal organs and diseases of the pancreas.

  The concentration of the enzyme aspartate aminotransferase in human blood increases greatly in case of damage to the liver or heart muscle, due to alcohol abuse, the indicators can increase two times relative to the norm.

  High values ​​of the enzyme gamma-glutamyltransferase are observed in patients with acute hepatitis, extra- and intrahepatic cholestasis, alcoholism, pancreatic and prostate cancer, and primary liver tumors.