An Overview of Transaminitis

What to Know About Elevated Liver Enzymes

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Transaminitis refers to elevated levels of certain liver enzymes, called transaminases, that are detected via a blood test. It isn’t a medical condition, but an outcome on a laboratory test that usually needs further medical investigation. Elevated transaminase enzymes might be a sign of liver disease or another medical condition. Transaminase elevation, elevated liver enzymes, and hypertransaminasemia are other terms sometimes referring to the same thing.

In the general population, the number of people with elevated levels might be 10% or higher. However, only 5% or less of these individuals have a serious problem with their liver.

Transaminitis
Verywell / Gary Ferster 

Symptoms

Elevated transaminase enzymes may be an indicator of medical conditions that can cause certain symptoms. These might include:

  • Fatigue
  • Itchy skin
  • Yellowed skin (jaundice)
  • Abdominal pain or swelling
  • Swelling in the legs and ankles
  • Nausea or vomiting
  • Excess bleeding from poor blood clotting

However, in many cases, people have elevated transaminase enzymes without having any symptoms. This may be especially likely if the elevations in these enzymes are not severe.

Causes

Liver Function

To understand what causes elevated transaminases and why they might be a concern, it is helpful to understand a little about the liver. Your liver is an organ that serves a variety of functions, including breaking down parts of some nutrients and removing certain toxins and metabolic byproducts.

It also plays important roles in making certain proteins, including ones used for blood clotting and for fluid management in the body.

Damage to the liver can cause many different symptoms and problems.

Transaminases

Transaminases are a type of enzyme important for the synthesis of amino acids (the building blocks of protein). They are also called aminotransferases. Usually, the term “transaminase” is used to refer to one of two specific enzymes: aspartate transaminase (AST) or alanine transaminase (ALT).

These enzymes can be found in the liver, but also to a lesser extent in other organs, such as the skeletal muscles, heart, and kidneys (particularly AST).

Conditions Causing Elevated Transaminases

Liver Disease

A number of different medical conditions can cause minor or major liver damage. This causes the release of AST and ALT into the bloodstream, causing elevated levels to show up on blood tests. Some of these potential causes include nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, liver infection (such as from hepatitis B or C), autoimmune disorders (like autoimmune hepatitis or primary biliary cholangitis), and rare genetic diseases like Wilson’s disease, hereditary hemochromatosis, or alpha-1 antitrypsin deficiency.

In the United States, the most common cause of mildly elevated transaminase levels is nonalcoholic fatty liver disease (NAFLD).

NAFLD is associated with metabolic syndrome, elevated triglycerides, low HDL cholesterol, high blood pressure, increased waist circumference, obesity, and insulin resistance (such as in pre-diabetes or type 2 diabetes).

Liver Problems From Medications

Transaminases might also be elevated as a reaction to certain medications. This might be particularly likely if a person is taking more than one medication that might damage the liver. Some common medications that sometimes cause elevations in transaminases include blood pressure medications (lisinopril), statin drugs (atorvastatin), antibiotics (ciprofloxacin), and medications for autoimmune disease (methotrexate).

Pain relievers (acetaminophen or aspirin), antidepressants (bupropion), drugs for acid reflux (omeprazole), and various over-the-counter herbal products can also result in an elevated reaction.

Diseases of Other Systems

Medical conditions that affect other parts of the body can also sometimes cause elevated transaminases. (This is particularly true of elevations of AST as opposed to ALT). Some of these problems include:

  • Thyroid disorders
  • Celiac disease
  • Abnormal breakdown of red blood cells (hemolysis)
  • Certain muscle disorders (like polymyositis)

Diagnosis

Elevated levels of transaminases are found from blood tests for ALT and AST. If your AST and ALT are elevated, you might be told that you have transaminitis. You also might be told that you have elevated liver function tests (LFTs). Liver function tests include not just AST and ALT, but other tests such as albumin and bilirubin.

These can give other information about how the liver and other organs might be functioning. These tests are often performed as part of the medical diagnosis for a number of different problems. Sometimes, people learn that they have elevated liver enzymes even when they haven’t noticed troublesome symptoms.

If you have elevated transaminases, your clinician will want to contextualize this with your overall health. The ratio of AST and ALT can give an indication of what type of problem might be going on. The amount of elevation is also an important diagnostic clue. For example, very high levels of transaminases likely indicate more severe, recent liver damage.

Medical history and exam are also important to consider. These can help your clinician gain clues about the potential causes of your elevated transaminases. For example, it’s important that your clinician ask you about your alcohol intake and your medications. Your clinician will also examine you for any signs of liver disease (or that of other organ systems).

Additional medical tests may also be needed. Depending on the situation, these might include additional liver function blood tests, INR (International normalized ratio) blood test, a complete blood count (CBC), iron tests, tests for hepatitis, tests for triglycerides, total cholesterol, a glucose A1C test, and/or additional tests for non-liver causes (like thyroid tests).

If transaminase levels don’t go down with treatment, follow up tests might be needed. These might include:

  • Blood tests for rare causes of liver disease (like Wilson disease)
  • Additional tests for non-liver causes (like thyroid tests)
  • Ultrasound of the liver
  • Liver biopsy

In difficult-to-diagnosis situations, a referral to a gastroenterologist may be helpful.

Diagnosis Caveats

Elevated transaminases are not always a good indicator of how well the liver is functioning. With mild increases, there might be damage to the liver, but not enough to impair its functions. Also, increases in transaminases (particularly AST) can sometimes be caused by other kinds of medical problems.

Additionally, sometimes people may have severe liver damage but not necessarily elevated transaminases. High levels of AST and ALT usually indicate significant ongoing damage to the liver. But a person with severe liver disease might have had previous damage to the liver without showing a currently elevated AST or ALT. In this case, other tests can help fill out the clinical picture.

Treatment

Elevated transaminases may indicate that you need treatment of some sort. This will depend on the underlying cause and its severity. People with symptoms of liver disease along with elevated transaminases may need more prompt interventions.

For example, if your clinician suspects nonalcoholic fatty liver disease, lifestyle interventions are usually the first recommended treatment. This might include losing weight, avoiding foods that contain fructose, engaging in rigorous physical exercise, and limiting alcohol intake. Depending on the situation, other treatments might include antiviral treatments for viral hepatitis or stopping a drug causing liver damage.

You may need repeat AST, ALT, and other liver function tests after you start your treatment. This can help show how well you are responding to the treatment. Sometimes these tests reveal that mildly elevated levels of transaminases have gone down, even without treatment.

Taking Steps to Stop Liver Disease

If you do have a type of liver disease, it’s important to halt the progression of liver damage. Even if you don’t have symptoms now, your liver might be becoming gradually more damaged over time.

Eventually, this might cause life-threatening liver failure. Taking steps now may help you prevent long-term problems.

A Word From Verywell

You might be alarmed if you’ve been told you have transaminitis or elevated liver tests. It might be especially surprising if you had no idea that your liver could be at risk. However, try not to panic. Your doctor will probably need to find out more to let you know what is going on. In most cases, your clinician will be able to work with you to help protect your liver and your future health. Don’t hesitate to ask if you have any questions about possible diagnosis or treatment.  

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Article Sources

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