Suganti Devi is 30 weeks pregnant with idiopathic cholestasis, is likely to present with following features except:
(A) Serum bilirubin of 2 mg/dl (B) Serum alkaline phosphatase slightly elevated (C) SGPT of 200 units (D) Prolongation of prothrombin time
(D) Let’s see each option separately.
Option “a” Serum bilirubin of 2 mg/dL.
Bilirubin level rarely exceed 5 mg%.
Bilirubin levels are usually between 2-5 mg/dL i.e. Option “a” is correct.
Option “b” Serum alkaline phosphatase of 30 KAU.
“Alkaline phosphatase may be mildly elevated.”
Robbins 7/e, p 921
i.e. alkaline phosphatase levels may be normal also. Hence, option b is correct.
Option “c” SGPT of 200 units.
“Serum transaminases levels are normal to moderately elevated but seldom exceed 250 IU/L.”
Williams Obs. 23/e, p 1064
i.e. Serum transaminases (SGPT) may be 200 units.
Option “d” Prolongation of prothrombin time
“Prothrombin time is usually normal unless there is malabsorption.”
Mgt of High Risk pregnancy – SS Trivedi, Manju Puri, p 356
Prothrombin is coagulant factor II. Its formation in liver is dependant on fat soluble vitamin K. Absorption of vitamin K occurs with bile acid. In cholestasis absorption of bile acid (vitamin K) is not affected, rather there is accumulation of bile acids, so levels of vitamin K and clotting factors dependant on vitamin K are also normal. The prothrombin time therefore, remains normal in cholestasis.
Only when ursodeoxycholic acid or cholestyramine are being given to patients of cholestasis. Prothrombin time needs to be monitored because these drugs decrease the absorption of bile acids and can therefore cause prolongation of prothrombin time.