title: Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia.
abstract: BACKGROUND
  Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. While hepatitis is a well-known complication during the treatment phase of ALL, the association of abnormal liver biochemistries at initial presentation of leukemia is poorly described. The aim of this study is to examine the prevalence and assess the clinical impact of hepatitis at diagnosis in children with ALL.
  
  
  METHODS
  All children diagnosed with ALL at BC Children's Hospital between 2001 and 2006 were included. Charts were reviewed and data recorded to a computerized spreadsheet. Descriptive statistical analyses were performed.
  
  
  RESULTS
  One hundred forty-seven ALL patients were identified. Over one third of patients had abnormal liver transaminase values (AST and/or ALT). Of the patients with abnormal transaminases, (52%) had ALT elevations twice the upper limit of normal. Risk factors for elevated transaminases included a high WBC count at diagnosis, older age, bulky disease, and T-cell leukemia. Conjugated hyperbilirubinemia was observed in 3.4% of subjects. Of these cases, 60% received steroids prior to induction chemotherapy and all had rapid resolution of their hyperbilirubinemia to normal levels.
  
  
  CONCLUSIONS
  Elevated transaminases are common at initial presentation of ALL and are likely due to hepatic injury from leukemic infiltrates. Conjugated hyperbilirubinemia at presentation may require treatment modification and dose reduction. A short course of steroids prior to initiation of induction chemotherapy appears to result in rapid resolution of the hyperbilirubinemia with subsequent ability to provide full dosing of induction chemotherapy.
authors.affiliation: Division of Pediatric Gastroenterology, Department of Pediatrics, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Idit
authors.initials: I
authors.lastname: Segal
authors.forename: S Rod
authors.initials: SR
authors.lastname: Rassekh
authors.forename: Mason C
authors.initials: MC
authors.lastname: Bond
authors.forename: Christof
authors.initials: C
authors.lastname: Senger
authors.forename: Richard A
authors.initials: RA
authors.lastname: Schreiber
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D006505:Hepatitis / Q000150:complications* / Q000473:pathology; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications*; D007223:Infant; D008099:Liver / Q000201:enzymology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications* / Q000628:therapy
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin