Aspartate and alanine aminotransferases

These enzymes are released when there is cell damage causing an increase in permeability of the cell membrane or cell necrosis. The main value of the aminotransferases is in detecting hepatocellular damage and monitoring the patient's progress. The levels rapidly return to normal following resolution of the factors causing hepatocellular damage. Because they are so non-specific, raised levels of these enzymes are of little value alone in generating a differential diagnosis; however, a very high level (greater than 1000 IU/L) is strongly suggestive of acute hepatitis of viral, drug, or ischemic origin.

Aspartate aminotransferase (AST) is released into blood when there is damage to any one of a number of organs, including the liver, heart muscle, skeletal muscle, kidney, pancreas, and red blood cells. There is no method available for differentiating the organ source of a raised AST and therefore it is a relatively non-specific test.

Alanine aminotransferase (ALT) is far more specific to the liver than AST, but is still present in low concentrations in other tissues and thus can still be raised in conditions such as myositis. ALT tends to rise and fall in tandem with AST; however, a small increase in ALT can often be found prior to, or without, a rise in AST.

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