High alkaline phosphates

Hello! I was diagnosed with psc when it shut off my gallbladder in 2004. I have done rather well with minimal issues. I had ercps every two years and now every year for the past 3. I am due for one in January 30th . I am feeling extremely tired and my chest aches for the last few weeks. Had blood work done this week and ast is 120,alt is 99 and my alkaline phosphates are at 682. I know this means a blockage but by the numbers can you tell anything else? How blocked? Cancer? Any info would sure help. I asked to up my ercp closer but my specialist doesn’t have any openings.

Hi Wendy,
What was your bilirubin, INR, creatinine on last labs?


I honestly don’t know. They just said everything else that was in good
range. I can call them tomorrow if that helps you with ideas.

Those numbers are needed to figure MELD score which gives a better idea of how your PSC is progressing. Ask them for the following.

  1. Bilirubin(mg/dl)
  2. Serum Sodium(mEq/L)
  3. INR
  4. Serum Creatinine(mg/dl)

Have you had dialysis twice, or 24 hours of CVVHD, within a week prior to the serum creatinine test?
Yes No

No I have not had any dialysis. These are from 10 months ago not this
week’s tests. I will have to call for new results. They were bilirubin
direct .02. bilirubin total was .05. serum sodium 141. Inr 10 and serium
creatine .08

Wendy Sue,
Double check that bilirubin level. The level couldn’t be .05. The lowest it goes is .50. Also, are you sure your INR is 10 and not 1.0?
Assuming that your bili is .50 and your INR is 10, you would have a MELD score of 32 based on the information you gave me. IF this is true, and I say IF as you need to verify all this information, you need to be on the transplant list NOW!
Not trying to scare you or anything, so please verify your labs again. Here’s the link where you can check your own MELD score. And if your MELD shows anywhere higher than 15, I would definitely be asking to be listed. Make sure you are seeing a hepatologist not just an ordinary GI.

Here’s the link for MELD - https://optn.transplant.hrsa.gov/resources/allocation-calculators/meld-calculator/

Let me know what you find.


Bilirubin is 0.5 and the inr is 10 with value of 1.0. I have a help Dr and
he is one of the best in the United States. Just isn’t a people person so I
don’t get any info. We talk for about 30 seconds before every ercp. That’s
it! :confused:

Oh, great. I feel much better now. Not sure what they mean by INR being 10. it’s the 1.0 value that’s key though. Glad to know it isn’t way up there.

You need more than 30 seconds out of him. I assume you go in for clinic visits as well. Hopefully you are seeing either he or another hepatologist in clinic where you get 15-20 minutes or whatever’s needed to address your concerns. If not, you need to slow them down and demand the time you need to discuss your PSC issues when they come up. Glad though your ERCP’s are going well for you.

Wishing you continued stable labs!

Merry Christmas.