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Alpha 1 Anti-Trypsin Deficiency

(AAT Deficiency; Alpha-1 Antiprotease Deficiency)

Definition

Alpha 1 anti-trypsin (AAT) deficiency is a rare genetic disorder that causes the enzyme AAT to not work well. It can cause lung and liver disease in children and adults.

Causes

AAT deficiency is an inherited disorder. It is passed from parents to children. This condition occurs when the liver does not make useful AAT. AAT is a protein that protects the lungs and other organs from damage. When functional AAT levels are too low, lung damage may occur.
People with AAT deficiency can also develop liver disease. AAT deficiency is one of the major causes of genetic liver disease in children. The liver makes an abnormal version of AAT protein that builds up in the liver. This blockage can damage liver cells. In some cases, severe liver damage can occur.

Risk Factors

If either of your parents have the gene for AAT deficiency, you are at risk of developing problems due to the disease. If both your parents carry the gene, you are at higher risk of having severe problems.

Symptoms

The first symptoms of the disease often appear in adulthood between the ages of 20-50 years:
In addition, if the liver is affected in adults, the following symptoms may be present:
Symptoms in children can occur in the first weeks of life or later in childhood.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a doctor who specializes in the lungs or liver, depending on the symptoms you are having.
Your bodily fluids and tissues may be tested. This can be done with:
Images may be taken of your lungs. This can be done with a chest x-ray.
Liver Biopsy
Placement of Liver Biopsy Needle
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Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Treatment for Lung Disease

Medications
You may be prescribed medications to boost the levels of AAT. These may be given weekly through an IV in your arm. If you have emphysema, your doctor may treat you with inhaled steroids and other medications to improve your breathing.
Smoking Cessation
If you smoke, your doctor will work with on ways to quit. Smoking can increase the damage to your lungs.

Treatment for Liver Damage

There is no specific treatment for liver disease due to AAT deficiency. Treatment focuses on symptoms and preventing complications. Treatment may include:
  • Vitamin supplements, such as E , D , and K
  • Medications to reduce itching and jaundice
  • Rarely, a liver transplant

Prevention

You cannot prevent AAT deficiency if you have inherited the condition. If you have AAT deficiency, you can reduce your chance of emphysema:

RESOURCES

Alpha-1 Association http://www.alpha1.org

American Lung Association http://www.lung.org

CANADIAN RESOURCES

Canadian Liver Foundation http://www.liver.ca

The Lung Association http://www.lung.ca

References

Alpha-1 antitrypsin deficiency. National Jewish Health website. Available at: http://www.nationaljewish.org/healthinfo/conditions/alpha-1. Accessed March 9, 2016.

Alpha-1 antitrypsin deficiency. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/pulmonary%5Fdisorders/chronic%5Fobstructive%5Fpulmonary%5Fdisease%5Fand%5Frelated%5Fdisorders/alpha-1%5Fantitrypsin%5Fdeficiency.html. Accessed June 2014. Accessed March 9, 2016.

Alpha-1 anti-trypsin deficiency (AAT). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 5, 2015. Accessed March 9, 2016.

COPD. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 10, 2016. Accessed March 9, 2016.

Hericks AJ. An overview of alpha-1 antitrypsin deficiency. Mo Med. 2007;104(3): 255-259.

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