The prevalence of elevated alanine transaminase and its possible causes in the general Korean population.

GOALS: The goal of the study was to investigate the current prevalence and causes of elevated alanine transaminase (ALT) in the general Korean population. BACKGROUND: Incidentally elevated ALT is frequently found because of increasing access to hospitals and blood tests. STUDY: A population-based cross-sectional study was carried out based on the Fourth Korean National Health and Nutrition Examination Survey (K-NHANES). Eligible subjects included 7894 men and 10,197 women. We defined elevated ALT as >43 U/L. Among the subjects with elevated ALT, those who consumed alcohol, had the hepatitis B surface antigen (HBsAg), were obese (body mass index ≥25 kg/m), were insulin resistant (the homeostasis model assessment-insulin resistance), or had metabolic syndrome (MetS) were investigated. RESULTS: The prevalence of elevated ALT was 7.4% in the Korean population. Increased ALT was more common in men (11.6%) than in women (3.1%) (P<0.001). Subjects with hypertension, diabetes, dyslipidemia (cholesterol ≥240 mg/dL or triglycerides ≥150 mg/dL), obesity, significant consumption of alcohol, HBsAg positive, or MetS were associated with elevated ALT (all P<0.001). The most common potential cause of elevated ALT was metabolic disorder (MetS, obesity, and/or insulin resistance), which comprised 74.9% of cases. MetS was found in 42.7% of men and 49.7% of women (P=0.031). Excess alcohol drinking was found in 29.6% of men and 7.5% of women with elevated ALT (P<0.001). HBsAg positivity was found in only 6% of subjects. CONCLUSIONS: Incidentally elevated ALT is common in the Korean population. It is associated with metabolic disorders (obesity, insulin resistance, or MetS) in the majority of patients. This finding suggests that nonalcoholic fatty liver disease might be the most common cause of elevated ALT in the general Korean population.

A Case of Non-Hodgkin's Lymphoma in Patient with Coombs' Negative Hemolytic Anemia and Idiopathic Thrombocytopenic Purpura.

Coombs' negative autoimmune hemolytic anemia (AIHA) is a rare disease which shares similar clinical and hematological features with Coombs' positive AIHA, but its exact frequency remains unknown. There have been few reports of idiopathic thrombocytopenic purpura (ITP) and Coombs' negative AIHA associated with other lymphoproliferative disorders (LPDs). Since there is a well known association between LPDs and autoimmune phenomena, it is important to investigate the possibility of an underlying malignancy. We report a case of ITP and Coombs' negative AIHA associated with diffuse large B-cell lymphoma.

A case of severe anemia by Necator americanus infection in Korea.

This report describes clinical and parasitological findings of an 82-yr-old female patient who lived in a local rural village and suffered from severe chronic anemia for several years. She was transferred to the National Police Hospital in Seoul for management of severe dyspnea and dizziness. At admission, she showed symptoms or signs of severe anemia. Gastroduodenoscopy observed hyperemic mucosa of the duodenum and discovered numerous moving roundworms on the mucosa. Endoscopy isolated seven of them, which were identified as Necator americanus by characteristic morphology of cutting plates in the buccal cavity. The patient was treated with albendazole and supportive measures for anemia, and her physical condition much improved. This case suggests the possibility that hookworm N. americanus is still transmitted in a remote local mountainous area in Korea.