What are liver function tests. How do AST and ALT enzymes indicate liver health. What are the normal ranges for AST and ALT. When should you be concerned about elevated liver enzymes.

The Importance of Liver Function Tests in Assessing Liver Health

Liver function tests (LFTs) are crucial diagnostic tools used to evaluate the overall health and functionality of the liver. These blood tests measure various enzymes, proteins, and substances produced by the liver, providing valuable insights into its condition. Among the most significant components of LFTs are the aminotransferase enzymes: Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT).

Why are LFTs so important? The liver plays a vital role in numerous bodily functions, including detoxification, protein synthesis, and the production of biochemicals necessary for digestion. By monitoring liver enzymes and other substances, healthcare professionals can detect liver damage or disease, often before symptoms become apparent.

Decoding AST and ALT: Key Indicators of Liver Health

AST and ALT are enzymes primarily found in liver cells. When the liver is damaged or diseased, these enzymes leak into the bloodstream, causing elevated levels in blood tests. Understanding the differences between AST and ALT can provide valuable insights into liver health:

Aspartate Aminotransferase (AST)

• Also known as Serum Glutamic Oxaloacetic Transaminase (SGOT)
• Present in various tissues, including liver, heart, muscle, and brain
• Less specific to liver damage due to its presence in other organs
• Normal range: 5 to 40 units per liter of serum

Alanine Aminotransferase (ALT)

• Also known as Serum Glutamic Pyruvic Transaminase (SGPT)
• Primarily found in liver cells
• More specific indicator of liver health
• Normal range: 7 to 56 units per liter of serum

Are elevated levels of these enzymes always cause for concern? While increases in AST and ALT can indicate liver damage, it’s essential to interpret these results in context. Temporary elevations can occur due to various factors, including intense exercise, certain medications, or minor liver irritations. Persistent or significantly elevated levels, however, may warrant further investigation.

Beyond AST and ALT: Other Crucial Components of Liver Function Tests

While AST and ALT are key indicators of liver health, a comprehensive liver function test panel includes several other important components:

1. Albumin: A protein produced by the liver, essential for maintaining proper fluid balance in the body
2. Total Protein: Measures the overall amount of protein in the blood
3. Alkaline Phosphatase (ALP): An enzyme found in various tissues, including the liver and bones
4. Gamma-glutamyl transferase (GGT): Another enzyme that can indicate liver or bile duct issues
5. Bilirubin: A waste product processed by the liver
6. Lactate dehydrogenase (LD): An enzyme released when cells are damaged
7. Prothrombin time (PT): A measure of blood clotting function, which can be affected by liver health

How do these components work together to provide a comprehensive picture of liver health? Each of these substances plays a unique role in liver function, and their levels can indicate different types of liver issues or diseases. For example, elevated bilirubin might suggest problems with bile flow, while low albumin levels could indicate chronic liver disease.

Interpreting Liver Function Test Results: When to Be Concerned

Interpreting liver function test results requires careful consideration of various factors. While the normal ranges for AST and ALT are generally 5-40 units/L and 7-56 units/L respectively, what constitutes a concerning elevation?

Mild elevations (up to 2-3 times the upper limit of normal) may not always indicate serious liver disease. These can result from:

• Alcohol consumption
• Certain medications
• Obesity
• Intense exercise
• Fatty liver disease

However, persistent elevations or levels exceeding 3 times the upper limit of normal often warrant further investigation. In such cases, healthcare providers may recommend additional tests, imaging studies, or liver biopsies to determine the underlying cause.

Is the ratio between AST and ALT significant? Indeed, the AST/ALT ratio can provide valuable diagnostic information. In alcoholic liver disease, for instance, the AST level is typically higher than ALT, often in a ratio greater than 2:1. Conversely, in viral hepatitis and other forms of liver disease, ALT is usually higher than AST.

Common Causes of Elevated Liver Enzymes

Understanding the potential causes of elevated liver enzymes can help in early detection and management of liver issues. Some common causes include:

1. Viral hepatitis (Hepatitis A, B, C)
2. Alcoholic liver disease
3. Non-alcoholic fatty liver disease (NAFLD)
4. Medication-induced liver injury
5. Autoimmune hepatitis
6. Hemochromatosis (iron overload)
7. Wilson’s disease (copper accumulation)
8. Liver cancer or metastases

How can identifying the cause of elevated liver enzymes guide treatment? Pinpointing the underlying cause is crucial for developing an effective treatment plan. For instance, viral hepatitis may require antiviral medications, while alcoholic liver disease necessitates alcohol cessation and supportive care.

Lifestyle Factors Affecting Liver Enzyme Levels

Various lifestyle factors can influence liver enzyme levels, sometimes leading to temporary elevations or masking underlying issues. Key factors include:

• Alcohol consumption: Even moderate drinking can cause temporary elevations in liver enzymes
• Diet: High-fat, high-sugar diets can contribute to fatty liver disease and elevated enzymes
• Exercise: Intense workouts can temporarily increase AST and ALT levels
• Weight: Obesity is a significant risk factor for non-alcoholic fatty liver disease
• Medications: Certain drugs, including some over-the-counter pain relievers, can affect liver enzyme levels

Can lifestyle modifications help normalize liver enzyme levels? In many cases, yes. Adopting a healthy diet, maintaining a healthy weight, limiting alcohol consumption, and exercising regularly can often help reduce elevated liver enzymes, particularly in cases of fatty liver disease or mild alcohol-related liver issues.

The Role of Liver Function Tests in Monitoring Chronic Liver Conditions

For individuals with chronic liver conditions, regular liver function tests play a crucial role in monitoring disease progression and treatment efficacy. These tests can help:

1. Track the progression of liver diseases such as cirrhosis or hepatitis
2. Assess the effectiveness of treatments for liver conditions
3. Detect potential complications early
4. Guide adjustments in medication dosages
5. Evaluate the need for more aggressive interventions or liver transplantation

How frequently should liver function tests be performed in chronic liver conditions? The frequency of testing depends on the specific condition and its severity. For stable chronic liver disease, tests might be done every 3-6 months, while more frequent monitoring may be necessary for active or progressing conditions.

Emerging Research and Future Directions in Liver Function Testing

As our understanding of liver physiology and pathology evolves, so too do the methods for assessing liver health. Recent advancements and future directions in liver function testing include:

• Non-invasive imaging techniques: FibroScan and magnetic resonance elastography for assessing liver fibrosis
• Biomarker panels: Combinations of markers that may provide more accurate assessments of liver health
• Genetic testing: Identifying genetic predispositions to liver diseases
• Metabolomics: Studying the unique chemical fingerprints left by cellular processes in the liver
• Artificial intelligence: Using machine learning to interpret complex patterns in liver function data

How might these advancements change the landscape of liver disease diagnosis and management? These new technologies and approaches have the potential to provide earlier, more accurate diagnoses, personalized treatment plans, and improved monitoring of liver health. They may also reduce the need for invasive procedures like liver biopsies in some cases.

In conclusion, liver function tests, particularly AST and ALT measurements, are invaluable tools in assessing and monitoring liver health. By understanding these tests, their interpretations, and the factors that can influence results, individuals can take proactive steps to maintain liver health and work effectively with healthcare providers to address any liver-related concerns. As research continues to advance, we can look forward to even more sophisticated and accurate methods of evaluating liver function, leading to improved outcomes for those affected by liver diseases.

Liver Function Tests-Ranges-High & Low

Liver Function Tests (LFT)

Liver function tests (LFT) are blood tests, which are commonly performed to assess liver functions or liver injury. LFT is also known by other names such as, liver panel, liver function panel, liver profile hepatic function panel, LFT.

An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. Under normal circumstances, these enzymes mostly reside within the cells of the liver.

But when the liver is injured for any reason, these enzymes are spilled into the blood stream. Enzymes are proteins that are present throughout the body, each with a unique function.

Enzymes help to speed up (catalyze) routine and vital chemical reactions in the body.

Liver function tests (also known as a liver panel) are blood tests that measure different enzymes, proteins, and other substances made by the liver. These tests check the overall health of the liver.

Following are the different substances often tested at the same time on a single blood sample for LFT:

• Albumin a protein made in the liver
• Total protein. This test measures the total amount of protein in the blood.
• ALP ALP(alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and gamma-glutamyl transferase (GGT). These are different enzymes made by the liver.
• Bilirubin, a waste product made by the liver.
• Lactate dehydrogenase (LD), an enzyme found in most of the body’s cells. LD is released into the blood when cells have been damaged by disease or injury.
• Prothrombin time (PT), a protein involved in blood clotting.

If levels of one or more of these substances are outside of the normal range, it may be a sign of liver disease.

Aminotransferase Enzymes (ALT, AST)

The aminotransferase enzymes catalyze chemical reactions in which an amino group from one amino acid (amino acids are building blocks of proteins) is transferred from a donor molecule to a recipient molecule, hence, the names “aminotransferases.”

Medical terms can sometimes be confusing, as is the case with these enzymes because they have interchangeable names that commonly appear in both medical and non-medical articles. For example:

• Another name for aminotransferase is transaminase.
• The enzyme aspartate aminotransferase (AST) is also known as serum glutamic oxaloacetic transaminase (SGOT).
• Alanine aminotransferase (ALT) is also known as serum glutamic pyruvic transaminase (SGPT).

Briefly, AST = SGOT and ALT = SGPT; they are enzymes produced by the liver and other types of cells.

Alanine aminotransferase (ALT)

Alanine aminotransferase (ALT) is present primarily in liver cells. In viral hepatitis and other forms of liver disease associated with hepatic necrosis, serum ALT is elevated even before the clinical signs and symptoms of the disease appear.

Although serum levels of both aspartate aminotransferase (AST) and ALT become elevated whenever disease processes affect liver cell integrity, ALT is a more liver-specific enzyme.

Serum elevations of ALT are rarely observed in conditions other than parenchymal liver disease. Moreover, the elevation of ALT activity persists longer than does AST activity.

Aspartate Aminotransferase (AST)

Aspartate aminotransferase (AST) is a transaminase enzyme that catalyzes the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate.

The AST enzyme was formerly known as serum glutamate oxalate transaminase (SGOT) and is present in all tissues except bone, with highest levels in liver and skeletal muscle. Concentration of AST is elevated after bruising, trauma, necrosis, infection, or neoplasia of liver or muscle.

The AST enzyme is found in cerebrospinal fluid, exudates, and transudates in proportion to the amount of cellular damage.

Where AST (aspartate aminotransferase) and ALT (aminotransferase enzymes) are Found

AST (SGOT) is normally found in a variety of tissues including the liver, heart, muscle, kidney, and brain. It is released into the serum when any one of these tissues is damaged.

For example, the AST level in serum is elevated in heart attacks or with a muscle injury. It is, therefore, not a highly specific indicator of liver injury as its elevation can occur as a result of other injured tissues.

ALT (SGPT) is, by contrast, normally found largely in the liver. This is not to say that it is exclusively located in the liver, but that is where it is most concentrated.

It is released into the bloodstream as the result of liver injury. Thus, it serves as a fairly specific indicator of liver status.

High (Elevated) Levels of AST and ALT

Following are the normal ranges of AST and ALT:

• The normal range of values for AST (SGOT) is about 5 to 40 units per liter of serum (the liquid part of the blood).
• The normal range of values for ALT (SGPT) is about 7 to 56 units per liter of serum.

The ranges of AST and ALT numbers may differ slightly depending on the technique and protocols used by different laboratories worldwide. However, normal reference ranges are routinely provided by each laboratory and printed with each patient’s individual report.

AST (SGOT) and ALT (SGPT) are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests.

However, it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not.

For example, elevations of these enzymes can occur with muscle damage. The interpretation of elevated AST and ALT results depends upon the entire clinical evaluation of an individual, and so it is best done by physicians experienced in evaluating liver disease and muscle disease.

Moreover, the precise levels of these liver enzyme tests do not correlate well with the extent of liver problems or the prognosis (outlook). Thus, the exact levels of AST (SGOT) and ALT (SGPT) cannot be used to determine the degree of liver disease or predict the future prognosis for liver function.

For example, patients with acute viral hepatitis-A may develop very high AST and ALT levels (sometimes in the thousands of units/liter range), but most patients with acute viral hepatitis-A recover fully without residual liver disease.

Again, patients with chronic hepatitis-C infection typically have only a little elevation in their AST and ALT levels while having substantial liver injury and even advanced scarring of the liver (cirrhosis) from ongoing minor inflammation of the liver.

Types of Liver Function Tests (LFT)

A liver function test is one of a group of tests that check levels of certain enzymes and other proteins in the blood. Some of the tests look for enzymes that are found in liver disease  and when the liver is damaged. Others check that the liver is working properly, the way it should.

Following are some of the blood tests reflect liver function:

• Coagulation panel (prothrombin time or PT, and international normalized ratio or INR): These tests measure blood’s ability for normal clotting and prevention of bleeding and bruising. This is the function of certain proteins called clotting factors that normally are produced in the liver. Normal values are about 9.5 to 13.8 seconds.
• Albumin level (hypoalbuminemia): Albumin is a very common protein found in the blood with a variety of functions. It also is produced only in the liver, and if its levels are lower than normal it can be suggestive of chronic liver disease or liver cirrhosis. Of note, many conditions other than liver disease also may cause low albumin levels. Normal values are about 3.5 to 5 g/dL.
• Bilirubin: This molecule is a byproduct of the routine destruction of red blood cells occurring in the liver. It is normally released as bile in the feces. Elevation of the bilirubin can suggest liver dysfunction. However, other conditions with increased destruction of red blood cells also can cause elevated bilirubin levels despite normal liver function. Normal values are about 0.1 to 1.0 mg/dL.
• Platelet count: Low platelet count (thrombocytopenia) has many causes, one of which can be advanced liver disease. Normal platelet counts are about 150,000 to 400,000 per (µL).
• Glucose: Glucose level is maintained in the body by a variety of mechanisms. The liver can release glucose in the blood for nourishment of other cells in case of starvation with insufficient oral intake of glucose. This process, called gluconeogenesis, is another major function of the liver. In advanced liver disease, this function of the liver can be compromised leading to unusually low glucose levels in the absence of adequate oral intake. Again, a large number of patients with liver cirrhosis become glucose intolerant and develop diabetes.
• GGT (Gamma-glutamyl transpeptidase): This enzyme is thought to indicate possible liver damage; the higher the abnormal level, the more likely there is liver damage. Normal levels of GGT are about 9 to 48 U/L.
• ALP (alkaline phosphatase): The liver synthesizes the highest amounts of this enzyme so high levels in the blood may suggest liver injury among other causes. Normal levels of ALP are about 45 to 115 U/L.
• LD or LDH (Lactate dehydrogenase): This enzyme may be elevated in many types of diseases, including liver disease. Normal levels are about 122 to 222U/L.

Reasons for Abnormal Liver Tests

Abnormal liver tests may be detected a variety of liver conditions in the blood. Some of those are the following:

• Mild to moderate elevations of the liver enzymes are common. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT readings in such cases are usually between twice the upper limits of normal and several hundred units/liter. One of the most common causes of mild to moderate elevations of these liver tests is a condition referred to as fatty liver disease (steatohepatitis or hepatic steatosis). In the United States, the most frequent cause of fatty liver disease is alcohol abuse.  

Alcoholic fatty liver disease only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time.

The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

Other causes of fatty liver include diabetes mellitus, and obesity. Fatty liver disease tests are composed of several tests including blood tests, CT and/or MRI scan tests, and in some patients, a liver biopsy.

• Hepatitis-B and Hepatitis-C are other causes of chronic mild to moderate liver enzyme elevation. In these conditions, ALT and AST may be only slightly high and the degree of abnormality in liver function tests can indicate the degree of injury.
• Chronic and acute alcohol use also can commonly cause abnormal liver blood tests. In alcoholic hepatitis, the range of liver tests can vary greatly. In chronic alcohol liver disease or alcoholic cirrhosis, slight elevation of ALT and AST may be observed, whereas, in acute alcoholic hepatitis, high liver enzyme numbers are often seen.
  
• Some medications can be responsible for a mild to moderate increase in the liver enzyme tests.

Medications that can cause increased liver enzyme tests (AST and ALT) levels

Following are examples of some of the common medications with potential liver toxicity:

Pain Relief Medications

• Aspirin
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Naprosyn, Naprelan, Anaprox, Aleve)
• Diclofenac (Voltaren, Cataflam, Voltaren-XR)
• Phenylbutazone (Butazolidine)

Anti-seizure Medications

• Phenytoin (Dilantin)
• Valproic acid ( Depakote)
• Carbamazepine (Tegretol)
• Phenobarbital

Antibiotics

• Tetracyclines (Achromycin)
• Sulfonamides
• Isoniazid (Nydrazid, Laniazid)
• Sulfamethoxazole (Gantanol)
• Trimethoprim(Trimpex; Proloprim, Primsol)
• Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
• Fluconazole (Dilflucan) and other anti-fungals

Cholesterol Lowering Drugs (Statins)

• Lovastatin (Mevacor, Altocor)
• Pravastatin (Pravachol)
• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Simvastatin (Zocor)
• Rosuvastatin (Crestor)
• Niacin

Cardiovascular Drugs

• Amiodarone (Cordaone)
• Hydralazine (Apresoline)
• Quinidine (Quinaglute, Quinidex)

Other Drugs

• Antidepressant drugs of the tricyclic type

With drug-induced liver enzyme abnormalities, the enzymes usually normalize weeks to months after stopping the medications. Typically, the physician will want to monitor the patient’s liver enzymes over time to confirm that the values are normalizing.

Diseases that can cause very high AST or ALT levels

AST and ALT serum levels in some liver conditions can range anywhere from ten times the upper limits of normal to thousands of units/liter.

The highest levels of AST and ALT are found with disorders that cause rapid death of numerous liver cells (extensive hepatic necrosis). Although this degree of liver enzymes elevation is not common, it can occur in such conditions as:

• Acute viral hepatitis A or B
• Profound liver damage inflicted by toxins as from an overdose of acetaminophen (brand-name Tylenol) or mushroom poisoning
• Prolonged collapse of the circulatory system (shock) when the liver is deprived of fresh blood providing oxygen and nutrients

Also, very high AST and ALT levels can be a result of severe muscle diseases.

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Standard liver tests – PMC

Clin Liver Dis (Hoboken). 2016 Jul; 8(1): 13–18.

Published online 2016 Jul 26. doi: 10.1002/cld. 562

, M.D.
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and , M.D.
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Author information Article notes Copyright and License information Disclaimer

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Abbreviations

AIH

autoimmune hepatitis

ALT

alanine aminotransferase

AMA

antimitochondrial antibodies

AP

alkaline phosphatase

AST

aspartate aminotransferase

DILI

drug‐induced liver injury

ERCP

endoscopic retrograde cholangiopancreatography

gGT

γ‐glutamyl transpeptidase; LIT, liver injury test

MELD

Model for End‐Stage Liver Disease

MRCP

magnetic resonance cholangiopancreatography

NASH

nonalcoholic steatohepatitis

PBC

primary biliary cholangitis

ULN

upper limit of normal

The liver is the largest organ in the body and arguably the most important organ for protein production and detoxification, both of which are facilitated by a myriad of enzymes. Both the detection of enzymes released from liver cells and proteins produced by the liver and released into the blood can be used to analyze liver health.

Standard liver tests (Tables and ) that assess injury to the liver include alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatases (APs). The excretory function of the liver can be estimated by bilirubin and the metabolic function of the liver by clotting tests and albumin.

Table 1

Standard Liver Tests, Their Sources of Origin, and Abnormalities

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Table 2

Elevation of Liver Chemistries With Liver Diseases

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Tests that describe injury of the liver such as aminotransferases and AP have historically been mislabeled liver injury tests (LIT). In contrast, standard tests such as albumin, bilirubin, and prothrombin time are useful in evaluating liver function.

The pattern of elevation of the different enzymes can be used to discriminate hepatocellular from cholestatic or mixed injury; AST and ALT are more elevated in patients with hepatocellular injury, whereas AP and γ‐glutamyl transpeptidase (gGT) are more elevated in cholestatic injury.

Normal values for laboratory results are defined as those found in 95% of a population. Thus, 2.5% of a population will be above and below the normal values, respectively. But being outside the normal does not immediately reflect illness; that is, a bilirubin level below normal has no clinical consequences. Contrarily, being within the normal value does not necessarily reflect a healthy state. In that regard it has been suggested to use an upper limit of 19 and 30 U/L for ALT for women and men, respectively,¹ to reflect healthy values. This also fits the observed increased mortality in individuals with ALT values that are normal but above the healthy range. ² Thus, liver transaminases likely will be described as healthy (≤19 U/L for women and ≤30 U/L for men) and normal values (i.e., <65 U/L). The normal values will depend on the specific laboratory population, thus limiting standardization.

For some assessments such as drug safety, the times upper limit of normal (ULN) is established to define safety margins. Substituting the healthy range values for normal range value will therefore need to be carefully addressed in the future.

Mild abnormalities in liver‐related tests may warrant repeat testing before a more extensive workup is initiated. Abnormal liver chemistries may occur in 1% to 4% of the asymptomatic population.³, ²¹

Transaminases are involved in transferring the amino groups of aspartate and alanine to ketoglutaric acid. Although ALT is more liver specific, elevated ALT levels are also reported in myopathies (Table ).⁴, ⁵

Table 3

Disease Association According to Aminotransferases Elevation Pattern

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Hepatocyte injury results in altered cell membrane permeability causing the excessive leakage of transaminases. Periportal hepatocytes (zone 1) have relatively more ALT, whereas the hepatocytes near the central vein (zone 3) have more AST (Fig. ). Thus, causes of hepatic inflammation that are predominantly involving zone 1 such as viral and autoimmune hepatitis result in predominantly ALT elevation. In contrast, ischemic or toxic insults are more likely to involve zone 3, causing a predominance of AST elevation. AST/ALT ratio, also known as De Ritis ratio, is useful in assessing various liver diseases.⁶ In alcoholic hepatitis, AST is usually higher than ALT, with the AST/ALT ratio reaching 2:1. In acute viral hepatitis, ALT levels are usually higher than AST. High AST/ALT ratio (>1.5) in acute viral hepatitis may be indicative of potential fulminant course.⁹ AST/ALT ratio greater than 1.0 in chronic liver diseases may be indicative of advanced fibrosis.⁸, ⁹ AST and ALT are also used together with platelets to assess the likelihood of advanced liver fibrosis and are part of the aspartate aminotransferase‐to‐platelet ratio index (APRI) and FIB‐4 score:

• APRI: AST level (/ULN) / platelet counts (10⁹/L) × 100

• FIB‐4 score: [age (years) × AST (U/L)]/{platelets (10⁹/L) × [ALT (U/L)]^1/2}.

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Zone 1 has more ALT than AST, and zone 3 has more AST than ALT. Autoimmune and viral hepatitis predominantly involve zone 1 (ALT > ALT). Ischemic and toxic events, heart failure, and Budd‐Chiari syndrome predominantly involve zone 3 (AST > ALT). AP is mostly present on basolateral membrane of hepatocytes lining the bile canaliculi. Reproduced from PLoS Biology. Copyright 2005, Frevert et al.

Aminotransferases are normal or only mildly elevated in obstructive jaundice except in acute phase of biliary obstruction caused by the passage of gallstone into the common bile duct.¹⁰ In this case, aminotransferases may reach values greater than 1000, decreasing quickly, with liver test rapidly evolving into those of typical cholestasis or normalizing completely.

Aminotransferases levels also vary with age, sex, race, and body mass index.¹¹ Levels are found to be higher in obese patients and lower in dialysis patients,¹² whereas ALT levels are noted to decline with weight loss. ¹³ AST levels are 15% higher in African American males as compared with Caucasians.¹¹ Some individuals may have asymptomatic AST elevation caused by a defect in clearance of the enzyme.¹⁴ Transaminases levels can be very high in patients with acute viral hepatitis, drug‐induced liver injury, hepatic ischemia, and Budd‐Chiari syndrome (Fig. ). In asymptomatic patients with no underlying disease, mild aminotransferase elevation for more than 6 months warrants further investigation.²²

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Typical AST elevation and De Ritis ratios for different kinds of liver diseases.

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Algorithms for evaluation of elevated aminotransferases (A), AP (B), and bilirubin (C), respectively. Abbreviations: AIH, autoimmune hepatitis; AMA, antimitochondrial antibodies; DILI, drug‐induced liver injury; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; NASH, nonalcoholic steatohepatitis; PBC, primary biliary cholangitis.

AP is the standard liver test reflecting cholestasis and can be complemented by gGT. gGT is part of a typical liver panel in some countries, whereas in the United States the standard liver test usually includes only AST, ALT, and AP. Because gGT is diffusely located in endoplasmic reticulum of bile ductal cells, its elevation is less specific for cholestasis but supports the suspicion that an elevated AP is liver derived as opposed to being of extrahepatic origin (Tables and ).¹⁵

Table 4

Elevated AP

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Elderly individuals older than 60 years, especially women, may have a mildly elevated AP. ¹⁶ Individuals with blood types O and B may have an elevation of the serum AP after eating a fatty meal because of the influx of intestinal AP into circulation.⁷ AP can also be nonpathologically elevated in children and adolescents undergoing rapid bone growth¹⁶ and in women late in normal pregnancies because of the influx of placental AP.¹⁷

Bilirubin, albumin, and prothrombin time are standard tests to evaluate the liver function.

Bilirubin is the result of enzymatic breakdown of heme. Bilirubin is conjugated in the liver, resulting in water solubility. The conjugated bilirubin is then secreted into the bile. In healthy individuals, conjugated bilirubin comprises a small proportion of total bilirubin.¹⁸

In adults, unconjugated bilirubin elevation is most often of extrahepatic origin, mainly caused by hemolysis. In the absence of hemolysis, isolated unconjugated hyperbilirubinemia in an otherwise healthy patient should raise the suspicion for Gilbert syndrome. Up to 5% of the population has Gilbert syndrome, which is due to partial defects in uridine 5′‐diphosphate‐glucuronosyltransferase, the enzyme that conjugates bilirubin.¹⁹ Crigler‐Najjar syndrome is a rare cause of unconjugated hyperbilirubinemia.

In adults, conjugated hyperbilirubinemia is almost always a sign of biliary obstruction or impaired hepatic function. Two rare hereditary conditions cause defects in the secretory mechanism, Dubin‐Johnson syndrome and Rotor syndrome, which result in elevated conjugated bilirubin.

Total serum bilirubin with increased prothrombin time correlates with poor outcomes in alcoholic hepatitis.¹⁸ Both are also critical components of Model for End‐Stage Liver Disease (MELD) score and Child‐Pugh score.

Serum albumin is exclusively synthesized by hepatocytes, but the long half‐life of albumin makes it difficult to interpret in the setting of acute liver injury. In chronic liver disease, albumin is the first of the three standard liver function tests to decline in advancing liver cirrhosis, before increase in bilirubin or prothrombin time. Albumin less than 35 g/dL should raise suspicion for cirrhosis. Differential diagnosis for hypoalbuminemia includes protein malnutrition of any cause, as well as protein‐losing enteropathies, nephrotic syndrome, and chronic infection.

With the exception of factor VIII, all coagulation factors are synthesized in the liver. Because of the short half‐lives of the coagulation factors, these are the best parameters to measure synthetic function of liver in acute conditions. This is most frequently done by prothrombin time determination. Because most clotting factors synthesized in the liver depend on vitamin K, prothrombin time is affected by vitamin K deficiency or use of vitamin K inhibitors. Vitamin K deficiency is seen in patients with chronic cholestasis or fat malabsorption from disease of the pancreas or small bowel. Prothrombin time is a better indicator of hepatic dysfunction than the international normalized ratio (INR),²⁰ despite INR having become a crucial part of the MELD score used for prioritizing liver allocations. In acute and chronic liver disease, prolonged prothrombin time (>5 seconds), which does not respond to parenteral vitamin K, is a poor prognostic sign.

Potential conflict of interest: Nothing to report.

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what you need to know about your liver health

Contents

• 1 Liver criteria
  • 1.1 Liver criteria: important information about the condition of a vital organ
  • 1.2 What are liver criteria and why they are important for health
  • 1. 3 Functions of the liver and its effects on the body
  • 1.4 Basic indicators of the state of the liver
  • 1.5 Determination of liver criteria through tests and examinations
  • 1.6 Normal values ​​​​of liver criteria and their interpretation
  • 1.7 Influence of liver criteria on health and disease prevention
  • 1.8 Dangerous deviations of liver criteria and their possible consequences
  • 1.9 Factors affecting liver criteria and how to normalize them
  • 1.10 Recommendations for monitoring liver criteria and preventing liver disease
  • 1.11 Importance of regular medical examination to control liver criteria
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What symptoms may indicate liver problems?
      • 1.13.0.2 What tests will help to find out about the condition of the liver?

Liver criteria (or liver chemistry) are used to assess liver function and identify possible pathologies. Learn what indicators are included in the liver criteria and how to interpret them for liver diagnosis and monitoring.

The liver is one of the most important organs in our body, responsible for many vital functions. It plays an important role in digestion, the processing and disposal of harmful substances, and the production of important proteins and hormones.

However, the liver is also a very vulnerable organ and can be damaged by various factors such as viruses, alcohol, improper diet and drugs. Therefore, it is important to know about the condition of your liver and the features of its work.

There are various methods and criteria to determine how healthy your liver is. One of these criteria is the level of alanine aminotransferase (ALT) in the blood. High ALT levels can be a sign of inflammation or damage to the liver.

It is important to pay attention to your liver and monitor its condition in order to prevent serious consequences. Knowing about liver criteria will help you see your doctor in a timely manner and take the necessary steps to keep your liver healthy.

Liver Criteria: Important information about the condition of a vital organ

The liver is one of the most important organs in our body, with many functions. It plays the role of a filter, cleansing the blood of toxins, is involved in metabolism, synthesizes bile and helps in the digestion of food. The liver also processes drugs and stores vitamins and minerals. It is important to know about the current state of the liver in order to take timely measures to maintain it and prevent the development of diseases.

The most reliable and accurate method for diagnosing liver diseases is a biopsy – taking a small sample of tissue for examination under a microscope. However, this method is not always possible or desirable due to its invasiveness and risks. Therefore, liver criteria based on blood tests and other biochemical parameters can be used to initially assess the state of the liver.

It is important to understand that liver criteria are only indicators and may not fully reflect the condition of the liver. They can be increased not only in liver diseases, but also in other pathologies of the body. Therefore, in case of detection of abnormalities in the liver criteria, you should always consult a doctor for further examination and accurate diagnosis.

What are liver criteria and why are they important for health

Liver criteria are a set of parameters that evaluate the state of the liver and determine the presence or extent of liver disease. These criteria include parameters such as liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total and direct bilirubin levels, and albumin and globulin levels.

Liver criteria identify the presence of liver disease in the early stages, when symptoms are not yet apparent. They can also be used to monitor the effectiveness of treatment and estimate disease prevalence. Regular testing for liver criteria allows you to identify possible problems and take steps to prevent or treat them.

Prevention of liver disease includes a healthy lifestyle, including proper nutrition, moderate alcohol consumption, smoking cessation, regular exercise, and avoidance of exposure to toxic substances. It is also important to undergo regular medical examinations and tests, including checking liver criteria, which will allow timely detection and prevention of liver diseases.

The functions of the liver and its effect on the body

The liver is one of the key organs in our body, performing a large number of important functions. Its influence on the work of the whole organism is very great.

One of the main functions of the liver is the processing of food. After digestion, food enters the liver, where it is decomposed into simpler components. Enzymes are produced here that are involved in the breakdown of fats, proteins and carbohydrates, as well as in the synthesis of glucose and glycogen.

The liver is also involved in the regulation of glucose levels in the body. It maintains a normal concentration of sugar in the blood, storing it in the form of glycogen and, conversely, releasing it when its level decreases. This is especially important for maintaining the energy balance in the body.

In addition, the liver is involved in cleansing the body of toxins and slag substances . It filters the blood, removes from it harmful metabolic products, medicines, alcohol and other substances that are incompatible with the vital activity of the body.

The liver is also involved in the formation of bile, which plays an important role in digestion. Bile not only breaks down fats, but also helps to absorb fat-soluble vitamins. It is secreted from the liver into the intestines and is involved in the process of digestion.

By removing toxins and waste products from the liver, synthesizing substances necessary for metabolism and absorption of nutrients, the liver plays a key role in the overall health of the body. Proper nutrition, regular fluid intake, and the absence of organ overload are of great importance so that the liver continues to perform its functions at the proper level.

Liver Health Indicators

Alanine aminotransferase (ALT) is an enzyme found in the liver that helps it process proteins in the body. A high ALT level may indicate liver problems such as hepatitis or cirrhosis.

Aspartate aminotransferase (AST) is another enzyme found in the liver. Elevated AST levels can also be a sign of liver damage, such as hepatitis or cirrhosis.

Gamma-glutamyltransferase (GGT) is an enzyme found in the liver, gallbladder and other organs. Elevated GGT levels may indicate problems with the liver or gallbladder, such as gallstones or alcoholic liver disease.

Albumin is a protein produced in the liver. Low albumin levels can be a sign of liver failure or other liver problems.

Total bilirubin is a pigment produced when red blood cells are broken down and the liver plays a role in its processing. High levels of bilirubin may indicate liver problems such as jaundice or blocked bile ducts.

In addition, there are other indicators such as alkaline phosphatase , alpha-fetoprotein and prothrombin time , which can be used to assess liver function and identify problematic situations. Often these indicators, together with general criteria, help in determining the condition of the liver and identifying any abnormalities in its work.

It is important to note that liver health scores can vary depending on many factors, including age, sex, family history, presence of other diseases, and use of certain medications. Therefore, if you have found abnormalities in your liver parameters, it is recommended to consult a doctor for additional analysis and consultation.

Determination of liver criteria through tests and examinations

Various tests and examinations are carried out to determine the condition of the liver and identify liver criteria. They allow you to evaluate the functionality of the body, identify the presence of possible diseases and determine the degree of their development.

Specialists may also refer to ultrasonography (ultrasound) of the liver to determine liver criteria. With the help of ultrasound, you can assess the size and shape of the liver, identify changes in the structure and the presence of tumors, as well as assess the condition of the biliary tract.

For a more accurate picture, sometimes more complex tests such as magnetic resonance imaging (MRI) or computed tomography (CT) are required. These methods provide detailed images of the liver and surrounding tissues, as well as detect the presence of tumors, cysts, or other formations.

It is important to note that the determination of hepatic criteria through tests and examinations should be carried out under the guidance of qualified specialists such as gastroenterologists or hepatologists. They will be able to evaluate the results and make the correct diagnosis, as well as prescribe the appropriate treatment, if necessary.

Normal values ​​of hepatic criteria and their interpretation

Many complex biochemical processes take place in the liver, and its state can be recognized by various indicators, which are called hepatic criteria. Normal values ​​of these criteria are an important indicator of liver health.

Another important hepatic criterion is Aspartate aminotransferase (AST). Normal AST values ​​also depend on gender and age. In men, they are up to 40 units / l, in women – up to 35 units / l. An increase in the level of AST can be associated with various pathologies, including liver diseases.

Creatinine is another indicator that helps assess liver function. The normal value of this indicator lies in the range from 44 to 97 micromol / l for men and from 44 to 80 micromol / l for women. An increase in creatinine levels may indicate a malfunction of the kidneys, which are closely related to the liver.

The concentration of bilirubin in the blood can also serve as an indicator of the state of the liver. Total bilirubin has a normal value of up to 20.5 µmol/L. In the case of an increase in the level of bilirubin, icteric changes occur, which indicate a malfunction of the liver and a violation of the metabolism of bile pigments.

Other important hepatic criteria include total protein, albumin, ammonia, and some other enzymes. The results of the analyzes of these indicators help to diagnose liver diseases and assess its functional state.

Influence of liver criteria on health and disease prevention

The liver plays an important role in the body with many functions, including blood purification, bile production and metabolism. The health of the liver directly affects the general condition of the body, so it is important to monitor the liver criteria and take measures to normalize them.

One of the main indicators of liver function is the level of alanine and aspartate transaminase (ALT and AST) in the blood. An increase in these enzymes may indicate liver damage, which can be caused by various causes, such as viral infections, alcohol or drug damage, fatty liver, and others. Regular monitoring of ALT and AST levels will help identify possible problems and start treatment in a timely manner.

Another important indicator of the state of the liver is the level of total protein and its fractions (albumin and globulin). With a reduced level of total protein, albumin, or an increased level of globulins, the synthetic function of the liver can be impaired. This may be due to nutritional deficiencies, liver disease, or other factors. Regular analysis of total protein and its fractions will help monitor liver function and take corrective measures if necessary.

Prevention of liver diseases includes the following measures: maintaining a healthy lifestyle, avoiding alcohol and smoking, proper nutrition, physical activity, regular preventive examinations by a doctor and adherence to vaccination recommendations. It is also important to avoid contact with toxic substances, take medicines only when prescribed by a doctor, and avoid self-medication. Regular monitoring of liver criteria and timely visits to a doctor will help identify problems in the liver in the early stages and prevent the development of serious diseases.

Dangerous deviations of liver criteria and their possible consequences

The health of the liver plays an important role in the overall health of the body. It performs many functions, including blood filtration, bile production, and metabolism. However, various factors can cause abnormal liver function, which can lead to serious consequences.

One of the main indicators of liver health is the level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood. Elevated levels of these enzymes may indicate inflammation or damage to the liver. If such deviations are not detected and eliminated in a timely manner, this can lead to the development of cirrhosis of the liver or even cancer.

In addition, elevated levels of bilirubin may also indicate problems with the liver. Bilirubin is a pigment that results from the breakdown of red blood cells in the liver. Elevated levels of this substance may be associated with impaired liver function or obstruction of the biliary tract. In such cases, the person may experience icteric discoloration of the skin and eyes, as well as other symptoms of liver failure.

In addition to these indicators, elevated levels of uric acid in the blood can also indicate problems with the liver. This may be due to metabolic disorders or hepatitis. High levels of uric acid can lead to the development of diseases such as gout.

Thus, regular monitoring of hepatic criteria is an important measure for assessing the condition of the liver and identifying possible abnormalities. If suspicious indicators are found, it is necessary to consult a doctor for further examination and treatment in order to prevent serious health consequences.

Factors affecting hepatic criteria and ways to normalize them

The liver is one of the most important organs of the human body, performing many functions. However, various factors can affect its performance and lead to a violation of hepatic criteria. One of the most common factors is malnutrition. Overeating fatty and fried foods, too much alcohol and sweets can cause liver dysfunction and increase liver criteria.

Diseases such as hepatitis, cirrhosis, and fatty degeneration can also affect liver performance. Inflammation of the liver caused by infection or other factors can lead to impaired organ function and increased hepatic criteria.

One way to normalize liver criteria is proper nutrition. Limiting fatty, fried, and sugary foods can help the liver recover and lower liver criteria.

It should be noted that physical activity and moderate exercise can also have a positive effect on the liver and contribute to its normalization. Regular exercise, walking and other forms of physical activity help strengthen the immune system and improve the general condition of the body, including liver function.

Guidelines for monitoring liver criteria and preventing liver disease

Liver health plays an important role in the overall health of the body, so monitoring its functions and preventing diseases is an integral part of a healthy lifestyle. There are several recommendations to help you keep your liver healthy.

It is important to keep an eye on your diet and stick to a healthy diet. Eating a large amount of fatty, fried and spicy foods can adversely affect the functioning of the liver and lead to the development of diseases. At the same time, it is necessary to increase the consumption of fruits, vegetables, greens, cereals and dairy products, which are rich in vitamins and minerals that positively affect the liver.

It is also important to consume alcohol in moderation to maintain a healthy liver. The systematic use of alcohol can adversely affect liver function, lead to cirrhosis and other serious diseases. It is better to stop drinking alcohol or reduce its level to a minimum.

The third recommendation relates to physical activity. Regular physical activity will help maintain a normal metabolism, strengthen the immune system and improve liver function. It is recommended to play sports or simply increase physical activity by doing morning exercises or walking in the fresh air.

Equally important is the correct use of medicines. Medicines can have a negative effect on the liver, especially when taken for a long time or in excess of doses. You should always strictly follow the instructions for use and consult your doctor if in doubt or side effects.

In conclusion, the control of liver criteria and the prevention of liver disease are important components of a healthy lifestyle. Proper nutrition, moderate alcohol consumption, and regular exercise will help maintain a healthy liver and overall well-being.

The importance of regular medical check-ups to control liver criteria

The liver is one of the most important organs in our body, responsible for purifying the blood, disposing of harmful substances and synthesizing substances necessary for the body to function. In this regard, monitoring the condition of the liver is an integral part of the medical examination.

Liver criteria reflect the functioning of the liver and allow detection of liver disorders at the earliest stages. This requires regular medical examinations, including blood tests for enzyme levels and other indicators related to liver function.

One of the important indicators is the level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). An increase in these enzymes may indicate the presence of inflammation or damage to the liver. In addition, examinations allow you to assess the level of bilirubin, which is associated with the formation and excretion of bile, and may indicate abnormalities in the liver.

Regular medical examination allows not only to identify problems with the liver, but also to take timely measures to correct them. If abnormalities are found, the doctor may prescribe the necessary treatment, recommend diet and lifestyle changes to maintain the functionality and health of the liver. In addition, regular monitoring of indicators allows you to track the effectiveness of the treatment and adjust it if necessary.

Thus, regular medical examination and monitoring of liver criteria are an important part of a healthy lifestyle. They allow you to detect liver dysfunction at an early stage and prevent the development of serious diseases. Therefore, it is necessary not to forget about your health and regularly consult a doctor for a preventive examination.

Related videos:

Q&A:

What symptoms may indicate liver problems?

Symptoms of liver problems may include jaundice, liver enlargement, alcohol consumption, loss of appetite, fatigue, and depression.

What tests will help to find out about the condition of the liver?

Common liver tests include alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, and hepatitis viruses.

Gamma-glutamyltransferase (GGT) – indications, norm, blood test

EN / ENG / UA

The enzyme was first described by Hanes et al. in 1952 GGT is a microsomal enzyme involved in amino acid metabolism. Catalyzes the transfer of ?-glutamyl residue from ?-glutamyl peptide to an amino acid or peptide (external transpeptidation), as well as to another substrate molecule (internal transpeptidation). Normally, the specific activity of the enzyme is higher than in blood serum, 7000-7500 times in the kidneys, 600-650 times in the pancreas, 200-500 times in the liver.

Insignificant activity of the enzyme is also recorded in the spleen, intestines, brain, lungs, skeletal muscles, heart, prostate. The enzyme is found in lysosomes, membranes, and cytoplasm of the cell, and membrane localization of GGT is characteristic of cells with high secretory, excretory, or reabsorption capacity. In the blood plasma of newborns, the activity of gamma-glutamyltransferase is 8-10 times higher than in adults, and even more in preterm infants.

During 7-9 months of life, GGT activity in the blood decreases, remaining constant until puberty. The level of the enzyme is also influenced by gender differences. In adolescents from 13 to 17 years old and in adults, the reference values ​​of gamma-glutamyl transpeptidase activity for women are 20-25% lower than for men.

Diagnosis of gamma-glutamyl transferase

Determination of GGT activity in blood serum has become of great importance for the diagnosis of diseases of the liver and hepatobiliary tract, and an increase in serum GGT values ​​is a sensitive indicator in diseases of the hepatobiliary system (marker of cholestasis)

Serum GGT levels increase in all forms of liver disease. The highest activity of the enzyme in cases of obstructive liver damage (5-30 times higher than normal values). This is a more sensitive indicator of liver pathology than ALT and AST in the diagnosis of obstructive jaundice, cholangitis and cholecystitis. The increase in GGT in these cases is observed earlier and lasts longer than other liver enzymes. The activity of gamma-glutamyl tranpeptidases in infectious hepatitis is 2–5 times higher than normal (in these cases, the determination of GGT is less useful than ALT and AST). In almost 100% of cases in cancer patients with liver metastases (without jaundice and with jaundice), a very significant increase in enzyme activity (12 or more times higher than normal) was found. Moreover, changes in activity gamma-glutamyltransferases are observed earlier and are more pronounced than the activities of other enzymes. A slight increase in GGT (2-5 times) is observed in patients with fatty degeneration of the liver.

An increase in enzyme activity is caused by many substances, especially drugs that can induce microsomal oxidizing capacity, as well as any oxidative stress (including diabetic ketoacidosis). After stopping the administration of drugs, GGT activity gradually returns to normal. In patients suffering from acute or chronic pancreatitis, malignant diseases of the pancreas, GGT activity, as a rule, exceeds the norm by 5–15 times.

High GGT activity was noted in the blood of alcoholics. There are certain differences between the activity of GGT in the blood of alcoholics and people who have taken a significant dose of alcohol (in the latter, even after severe intoxication, an increase in activity is observed only for 12 hours and does not exceed 15% of the norm). Therefore, gamma-glutamyltransferase is used to monitor the effectiveness of the treatment of patients with alcoholism. The high specific activity of GGT in the prostate gland, so it can be used as a marker of malignant diseases of the prostate gland. The study of GGT activity in brain lesions has acquired great clinical and diagnostic significance.

Parallel determination of the activity of GGT and alkaline phosphatase (in cases of its increased activity) helps when it is necessary to decide whether their source is an altered bone metabolism or the presence of hepatobiliary disorders, because. in conditions in which alkaline phosphatase is elevated (in healthy pregnant women, in children older than 1 year, in cases of bone diseases), GGT is within normal limits.

Indications for Gamma-glutamyltransferase test

1. Diagnosis and differential diagnosis of liver lesions
2. Monitoring of the course of pancreatic, prostate, hepatoma cancer
3. Screening for alcoholism, monitoring the treatment of people with chronic alcoholism
4. Evaluation of hepatotoxicity of drugs

Examination

Examination preparation: fasting blood sampling

Examination material: blood serum, avoid hemolysis

Method of determination : kinetic (IFCC)

Units : U/l

Reference values ​​(normal gamma-glutamyltransferase in blood)

Increased gamma-glutamyl transpeptidase values ​​

If you have high GGT, possible reasons for this may be:

1. Intra- and extrahepatic cholestasis
2. Acute viral hepatitis, toxic, radiation damage to the liver
3. Chronic hepatitis
4. Acute and chronic pancreatitis
5. Alcohol-induced liver injury
6. Infectious mononucleosis
7. Hyperthyroidism
8. Myotonic dystrophy
9. Diabetes mellitus
10. Kidney pathology (exacerbations of chronic glomerulo- and pyelonephritis)
11. Cancer of the pancreas, prostate, hepatoma
12. Taking medications (barbiturates, phenytoin, rifampicin, cephalosporins, estrogens, oral contraceptives, acetaminophen)

The cost of a blood test for the content of gamma-glutamyltransferase

A blood test for the content of gamma-glutamyltransferase costs 35 UAH. It is carried out within 1-2 days. The cost of taking material for research is paid separately (15 – 25 UAH).

You can get full information about the service from our laboratory assistant.

Medical equipment of our laboratory.

Consultation of a laboratory doctor

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