Liver function test: Purpose, types, and results

Liver function tests, commonly known as a liver panel, are blood tests used to measure liver performance through the analysis of various substances found in the blood, such as proteins, enzymes, and bilirubin. The tests can provide important insight into problems with the liver, such as inflammation, scarring, or liver damage. They are often used to diagnose and monitor diseases, including hepatitis and cirrhosis.

There are a variety of different types of liver function tests, and each one screens for different aspects of liver health. Here’s a look at the most common types of liver function tests, as well as their normal ranges and what abnormal results may mean.

What is a liver function test?

A liver function test is a blood test used to measure various substances in the blood that are indicative of hepatic function. In a single appointment, your healthcare provider can gain a better overall picture of your liver health and make diagnoses or recommendations for further testing based on the results.

During the test, a small blood sample is taken from a vein in the arm using a small needle. The sample is then sent to the laboratory for analysis, and the results will be available within several days, or in some cases even sooner. Although your healthcare provider may recommend that you fast for 10 to 12 hours prior to the test, liver function tests generally don’t require any other preparation.

What does a liver function test show?

Your healthcare provider may recommend a liver function test for a variety of reasons. Generally, the test is ordered if you have any symptoms or signs that might indicate a problem with your liver, such as:

• Yellowing of the skin and eyes, a condition known as jaundice
• Upper abdominal pain or swelling
• Nausea or vomiting
• Fatigue
• Loss of appetite
• Dark urine or light-colored stool

In some cases, your healthcare provider may order a liver function test as part of routine screening or to monitor the progression of an existing condition.

“It’s generally recommended to get a liver panel if you’re diagnosed with obesity or being overweight, are a heavy alcohol drinker, have been exposed to hepatitis viruses, or have a genetic disposition for liver disease,” says Edward Salko, MD, a board-certified physician and a medical director at PersonaLabs. 

The test results of a liver panel can also be used to help diagnose a variety of conditions, such as: 

• Cirrhosis
• Hepatitis A, B, and C
• Liver cancer
• Nonalcoholic fatty liver disease
• Wilson disease
• Celiac disease

What’s included in a liver panel? 

Based on your specific medical history and symptoms, your healthcare provider may order a number of different tests, explains Dr. Salko. Some common tests included in a liver function panel include:

• Alkaline phosphatase (ALP)
• Alanine transaminase (ALT), also known as alanine aminotransferase
• Aspartate aminotransferase (AST), also known as aspartate transaminase
• Gamma-glutamyl transferase (GGT), also known as gamma-glutamyl transpeptidase
• Albumin
• Total protein
• Bilirubin
• Lactate dehydrogenase (LDH)
• Prothrombin time (PT)

Liver function test normal range

The liver plays a role in nearly every bodily process, including metabolism, digestion, and immunity.   As such, a healthy and properly functioning liver is important for overall health. 

However, there are several factors that can affect how the liver functions, including age, sex, pregnancy, and certain medications, explains Dr. Salko. “Alcohol use, frequent eating out, and smoking cigarettes can also have adverse effects on the liver,” he adds.

Liver enzyme test

Liver enzyme lab tests measure the levels of certain enzymes in the blood that are released by liver cells. These enzymes help to speed up certain chemical reactions within the body, such as breaking down proteins and fats, helping blood clot, and fighting infection. Most commonly, doctors will order a test for four different enzymes:

• Alkaline phosphatase (ALP): 30–120 U/L
• Alanine transaminase (ALT): 10–40 U/L
• Aspartate aminotransferase (AST): 10–40 U/L
• Gamma-glutamyl transferase (GGT): 8–40 U/L for females, 9–50 U/L for males

“Elevations in both AST and ALT often mean that the liver is inflamed. The most common causes would include alcohol use, medications, fatty liver disease, and recent or current infections, such as COVID, mono, or other viruses,” says Max Pitman, MD, a medical director at Salvo Health and board-certified physician at Summit Health in Brooklyn, New York.

Abnormal levels of ALP could be an indicator of chronic liver disease, bone disease, or chronic kidney disease. However, additional laboratory tests are often needed to make the diagnosis. 

“Elevated GGT can be seen in many conditions such as alcohol use, gallstone or gallbladder issues, and medication use,” Dr. Pitman says. “Elevated GGT on its own is not cause for immediate concern but should be evaluated in the context of other abnormal liver tests. Small increases in liver enzymes (two to five times the upper limit of normal) are often temporary and not cause for excessive concern but should be followed up to make sure that they decrease to the normal level over time.”

Albumin

Albumin is a protein produced in the liver, and it plays an important role in transporting various substances throughout the body, including hormones and medications. An albumin test measures the levels of serum albumin, with a normal range being 3.5–5.5 g/dL.

Elevated levels of albumin may be a sign of dehydration, while low levels can be indicative of liver or kidney disease. Dr. Pitman adds that low albumin can also be a sign of malnutrition or chronic inflammation. 

Total protein test

The total protein test measures the total amount of proteins in your blood, including albumin and globulins. A normal range is typically 5.5–9.0 g/dL.

“Low total protein is a sign of malnutrition or chronic inflammation,” says Dr. Pitman. “Elevated total protein, particularly if it’s a very high level for a sustained period of time, should be checked out by your primary care physician or hematologist to make sure there is no underlying condition contributing to excess protein in the blood.” 

Bilirubin test

Bilirubin is a yellow substance naturally made as your body breaks down old red blood cells. A healthy liver will automatically remove the majority of the bilirubin from your body as a waste product. However, if the liver is not functioning properly, bilirubin will build up in the bloodstream and cause the skin to yellow, a condition known as jaundice.

The normal range of serum bilirubin levels is 0.3–1.0 mg/dL. If your bilirubin levels exceed this range, it may be a sign of a liver condition, but this isn’t always the case—certain medications and foods can also elevate bilirubin levels.

LDH test

LDH, which plays an important role in energy production, is an enzyme present in the cells of almost all organs and tissue. A normal range for LDH levels is 80–225 U/L. 

“Many different types of conditions can cause elevated LDH,” Dr. Pitman explains. “It’s not specific to any one condition. Some of these conditions involve inflammation, like infections, or rapid cell turnover, like in malignancy or certain types of anemia. Many other conditions can cause it as well, including autoimmune conditions, drug reactions, and much more.” 

Dr. Pitman adds that a high LDH on its own should not cause concern, but it should be evaluated in context with other symptoms and tests.

Prothrombin time (PT) test

Prothrombin time refers to the time it takes for the liquid portion of your blood, also known as plasma, to clot. A normal prothrombin time should be within 11-13 seconds. 

“Elevated PT means that blood clotting is not occurring as rapidly as normal and can indicate a risk of excessive bleeding,” Dr. Pitman says. “This is commonly seen in people who are taking blood thinners such as coumadin or Jantoven. It can also occur as a result of low vitamin K levels, certain inherited bleeding conditions, or in advanced liver disease, such as liver cirrhosis or acute liver failure.”

Next steps: What if I’m diagnosed with a liver condition?

Abnormal liver function test results can indicate a variety of liver conditions. While many of the symptoms of liver conditions are similar, the treatment will depend on the specific diagnosis.

It’s important to address any and all concerns you may have with your healthcare provider, as they can provide you with the best information and advice on how to manage your condition, as well as potential side effects of each treatment option. Additionally, Dr. Salko advises that diet and lifestyle changes may help improve overall liver function, as well as have a positive impact on other aspects of your mental and physical health.

Understanding The Normal Range Chart For Liver Function Tests

Your liver plays a vital role in keeping your body healthy, filtering out toxins and waste products. However, when your liver is not functioning properly, it can affect your overall health and wellbeing. That’s why liver function tests are crucial for detecting any abnormalities that could indicate liver disease or damage. In this article, we’ll take an in-depth look at liver function tests, what a normal range chart for liver function tests means, and how you can interpret the results of your liver function test.

Why Liver Function Tests are Important for Your Health

Liver function tests are a series of blood tests that provide your doctor with important information about the health and function of your liver. These tests measure the levels of enzymes, proteins, and other substances produced by your liver and can help identify liver damage or disease. If you have any risk factors for liver disease, such as excessive alcohol consumption, obesity, or a family history of liver disease, your doctor may recommend liver function tests to monitor your liver health.

It is important to note that liver function tests can also help diagnose other health conditions that may not be directly related to the liver. For example, abnormal liver function test results can indicate problems with the gallbladder or pancreas. Additionally, liver function tests can be used to monitor the effectiveness of certain medications and treatments that may affect liver function. Therefore, even if you do not have any known risk factors for liver disease, your doctor may still recommend liver function tests as part of your routine health check-up.

How Liver Function Tests Work: A Comprehensive Overview

Liver function tests typically involve a blood draw, which is then analyzed in a laboratory. There are several different types of liver function tests that can be performed, each measuring different aspects of liver function:

• Alanine aminotransferase (ALT) tests measure the levels of ALT enzymes, which are released when liver cells are damaged.
• Aspartate aminotransferase (AST) tests measure the levels of AST enzymes, which are also released when liver cells are damaged.
• Alkaline phosphatase (ALP) tests measure the levels of ALP enzymes, which are produced in liver cells and in the bile ducts.
• Bilirubin tests measure the levels of bilirubin, a waste product produced by the liver.
• Albumin tests measure the levels of albumin, a protein produced by the liver.
• Prothrombin time (PT) tests measure how quickly your blood clots, which can indicate liver damage or disease.

Your doctor may order one or more of these tests depending on your individual needs and medical history.

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It is important to note that liver function tests are not always conclusive and may need to be repeated or combined with other tests to get a complete picture of liver health. Additionally, certain medications and supplements can affect liver function test results, so it is important to inform your doctor of any medications or supplements you are taking before undergoing these tests.

If liver function tests indicate liver damage or disease, further testing may be necessary to determine the cause and severity of the condition. This may include imaging tests such as an ultrasound or MRI, or a liver biopsy, which involves taking a small sample of liver tissue for analysis.

What is a Normal Range Chart for Liver Function Tests?

When you receive your liver function test results, they will come with a normal range chart. This chart displays the normal levels of each liver enzyme or protein that was tested. The normal range can vary slightly depending on factors such as age, gender, and overall health, but in general, it provides a reference for what is considered healthy and expected for someone without liver disease.

For example, normal ALT levels range from 7 to 55 units per liter (U/L) for men and from 7 to 45 U/L for women. Normal AST levels range from 8 to 48 U/L for men and from 8 to 34 U/L for women. Normal ALP levels range from 45 to 115 U/L for adults. Normal bilirubin levels range from 0.1 to 1.2 mg/dL.

If your liver function test results fall within the normal range, it typically means that your liver is functioning as it should be. However, it’s important to note that not all liver diseases or damage may be detected through these tests, so it’s important to listen to your body and speak with your doctor if you have any concerns.

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It’s also important to note that certain medications, supplements, and lifestyle factors can affect liver function test results. For example, alcohol consumption, smoking, and certain medications like acetaminophen can cause elevated liver enzyme levels. It’s important to inform your doctor of any medications or supplements you are taking, as well as any lifestyle habits that may affect your liver function.

Interpreting the Results of Your Liver Function Test: What to Look For

If your liver function test results fall outside of the normal range, it could indicate liver disease or damage. Your doctor will help you interpret your results and determine the next steps in your treatment plan.

For example, high levels of ALT or AST could indicate hepatitis, cirrhosis, or other types of liver damage. High levels of bilirubin could indicate a blocked bile duct or other liver disease. Low levels of albumin could indicate liver disease or malnutrition.

It’s important to note that abnormal liver function test results don’t always mean you have liver disease. Other factors such as medications, viruses, and alcohol consumption can also affect your liver function test results. That’s why your doctor will take into account your medical history and other factors before making a diagnosis.

It’s also important to note that liver function tests are not always accurate indicators of liver health. In some cases, a person with liver disease may have normal liver function test results, while a person without liver disease may have abnormal results. Therefore, your doctor may order additional tests or imaging studies to get a more complete picture of your liver health.

Understanding the Different Types of Liver Function Tests

As we discussed earlier, there are several different types of liver function tests that can be performed. Your doctor will determine which tests are necessary based on your individual needs and medical history.

In addition to the tests we mentioned earlier, there are also gamma-glutamyl transferase (GGT) tests, lactate dehydrogenase (LD) tests, and viral hepatitis tests that can help identify specific liver diseases or damage.

The gamma-glutamyl transferase (GGT) test measures the levels of GGT in the blood, which is an enzyme produced by the liver. High levels of GGT can indicate liver damage or disease, as well as heavy alcohol consumption. This test is often used in conjunction with other liver function tests to provide a more complete picture of liver health.

Lactate dehydrogenase (LD) tests measure the levels of LD in the blood, which is an enzyme found in many organs including the liver. Elevated levels of LD can indicate liver damage or disease, as well as other conditions such as heart attack or muscle injury. This test is not specific to liver function, but can be used in combination with other tests to help diagnose liver problems.

The Role of Liver Enzymes in Liver Function Testing

Enzymes are proteins that help catalyze chemical reactions in the body. The liver produces several enzymes, including ALT, AST, and ALP. When liver cells are damaged or destroyed, these enzymes are released into the bloodstream, where they can be detected through liver function testing.

While high levels of these enzymes can indicate liver damage or disease, it’s important to note that not all liver diseases cause elevated enzyme levels, and not all elevated enzyme levels indicate liver disease.

One important factor to consider when interpreting liver function test results is the patient’s age and sex. Studies have shown that normal enzyme levels can vary depending on these factors, so it’s important to take them into account when evaluating results.

Additionally, certain medications and supplements can affect liver enzyme levels, so it’s important to inform your healthcare provider of any medications or supplements you are taking before undergoing liver function testing.

Common Causes of Abnormal Liver Function Test Results

There are many factors that can affect your liver function test results. Some common causes include:

• Excessive alcohol consumption
• Obesity or type 2 diabetes
• Hepatitis viruses
• Fatty liver disease
• Liver cancer
• Medications or supplements that can affect liver function

If you have any risk factors for these conditions, your doctor may recommend more frequent liver function testing to monitor your liver health.

Another common cause of abnormal liver function test results is autoimmune hepatitis, which is a chronic disease in which the immune system attacks the liver. This can lead to inflammation and damage to the liver, resulting in abnormal liver function test results.

In addition, exposure to certain toxins or chemicals can also affect liver function and lead to abnormal test results. For example, exposure to high levels of pesticides or industrial chemicals can cause liver damage and affect liver function.

Lifestyle Changes to Improve Your Liver Health and Function

In addition to regular liver function testing, there are also steps you can take to support your liver health and function. Some lifestyle changes that may be beneficial include:

• Eating a balanced, healthy diet that’s rich in fruits, vegetables, and whole grains
• Maintaining a healthy weight
• Limiting alcohol consumption
• Avoiding smoking and other tobacco products
• Getting regular exercise

These lifestyle changes can help reduce your risk of liver disease and promote overall health and wellbeing.

Another important lifestyle change to consider is reducing your intake of processed foods and saturated fats. These types of foods can contribute to liver damage and inflammation, which can lead to liver disease over time. Instead, focus on incorporating more lean proteins, healthy fats, and complex carbohydrates into your diet.

When to Consult a Doctor About Abnormal Liver Function Test Results

If your liver function test results fall outside of the normal range, it’s important to speak with your doctor about what steps you can take to address any underlying liver disease or damage.

Your doctor may recommend additional testing, lifestyle changes, or medication depending on your specific needs and medical history.

It’s important to note that abnormal liver function test results can be caused by a variety of factors, including alcohol consumption, viral infections, autoimmune disorders, and certain medications. Therefore, it’s crucial to consult with a doctor to determine the underlying cause of the abnormal results and develop an appropriate treatment plan.

The Relationship Between Alcohol Consumption and Liver Health

Excessive alcohol consumption can have a significant impact on liver health. Alcohol can cause liver damage and contribute to the development of conditions such as fatty liver disease and cirrhosis. That’s why it’s important to limit alcohol consumption and speak with your doctor if you need help cutting down or quitting altogether.

In addition to limiting alcohol consumption, there are other steps you can take to support liver health. Eating a balanced diet, exercising regularly, and avoiding exposure to toxins can all help keep your liver functioning properly. It’s also important to get regular check-ups with your doctor to monitor liver function and catch any potential issues early on.

Non-Alcoholic Fatty Liver Disease: Symptoms, Diagnosis, and Treatment

Non-alcoholic fatty liver disease (NAFLD) is a condition that occurs when excess fat builds up in the liver. It’s becoming increasingly common, particularly in people with obesity or type 2 diabetes. Symptoms of NAFLD can include fatigue, abdominal pain, and yellowing of the skin and eyes. Diagnosis typically involves liver function testing and imaging tests such as ultrasound or MRI. Treatment may involve lifestyle changes such as weight loss and regular exercise or medication.

Recent studies have shown that NAFLD is not just limited to adults, but can also affect children. In fact, it is now considered the most common liver disease in children. Children with NAFLD may experience similar symptoms as adults, but may also have poor appetite, delayed growth, and difficulty concentrating. Diagnosis in children may involve blood tests and imaging tests such as ultrasound or MRI. Treatment for children with NAFLD may involve lifestyle changes such as a healthy diet and regular exercise, as well as medication if necessary.

Hepatitis C and Liver Function Testing

Hepatitis C is a viral infection that can cause liver inflammation and damage. If you’re at risk for hepatitis C, your doctor may recommend liver function testing to monitor your liver health and screen for the virus. Hepatitis C can be treated with antiviral medication, so it’s important to get tested and diagnosed as early as possible.

It’s important to note that hepatitis C can be spread through contact with infected blood, such as sharing needles or receiving a blood transfusion before 1992. It can also be transmitted through unprotected sex with an infected partner. If you think you may have been exposed to hepatitis C, it’s important to talk to your doctor about getting tested. Early detection and treatment can help prevent serious liver damage and improve your overall health.

Understanding the Importance of Regular Liver Function Testing

Regular liver function testing is an important part of maintaining your overall health and wellbeing. These tests can help identify liver disease and damage early on, when it’s often easier to treat and manage. Talk to your doctor about your individual risk factors and whether liver function testing is appropriate for you.

There are several risk factors that can increase your likelihood of developing liver disease, including heavy alcohol consumption, obesity, and viral hepatitis. Regular liver function testing can help detect any potential issues before they become more serious and lead to liver failure or other complications.

In addition to liver function testing, there are also lifestyle changes you can make to support liver health, such as maintaining a healthy weight, limiting alcohol consumption, and avoiding exposure to toxins. By taking a proactive approach to liver health, you can reduce your risk of developing liver disease and ensure that your liver is functioning optimally.

Natural Remedies to Support Healthy Liver Function

In addition to lifestyle changes, there are also certain natural remedies that may help support liver health and function. These can include:

• Milk thistle, an herbal supplement that has been shown to have antioxidant and anti-inflammatory effects
• Turmeric, a spice that contains curcumin, a compound with anti-inflammatory properties
• Dandelion root, an herbal supplement that has been used traditionally to support liver function
• Green tea, which contains catechins, antioxidants that may help protect the liver

While these remedies may have some benefits for liver health, it’s important to talk to your doctor before starting any new supplements or treatments.

In addition to the natural remedies mentioned above, there are other lifestyle changes that can support liver health. These include reducing alcohol consumption, avoiding processed foods and excessive sugar intake, and maintaining a healthy weight through regular exercise and a balanced diet.

It’s also important to note that certain medications and supplements can have negative effects on liver function. Always talk to your doctor or pharmacist before taking any new medications or supplements, especially if you have a history of liver disease or other medical conditions.

Conclusion

Liver function tests are a crucial tool for monitoring liver health and detecting liver disease or damage. By understanding what a normal range chart for liver function tests means, you can better monitor your own liver health and work with your doctor to address any abnormalities. Remember to maintain a healthy lifestyle and speak with your doctor if you have any concerns about your liver function.

preparation, table of normal values, interpretation

Biochemical blood test is a detailed study of the patient’s venous blood, conducted to assess the functioning of internal organs, detect deficiency of vitamins, enzymes, macro- and microelements, as well as to diagnose metabolic pathology. Blood biochemistry is more indicative than a general clinical analysis; the results of the analysis make it possible to detect many diseases at an early stage. That is why this study is recommended to be carried out not only as prescribed by a doctor, but also for preventive purposes at least once a year. The results of a biochemical blood test include many interconnected indicators and a doctor should be involved in their interpretation – self-medication is dangerous for your health!

How to prepare for the procedure?

• Blood sampling for biochemistry is always performed on an empty stomach, most often between 8 and 11 am. On the day of the procedure, non-carbonated water is allowed, and the day before the procedure, heavy food, carbonated drinks, strong coffee, tea and alcohol should be excluded from the diet.
• Do not smoke during the last hour before donating blood.
• Immediately before the procedure, try to avoid physical and emotional stress, the last 10-20 minutes it is better to just sit near the manipulation room.
• If the date of the biochemical blood test falls on the period of taking a course of drug treatment or a course of physiotherapy, then it is worth consulting with your doctor – he may recommend rescheduling the study to another time or interrupting the course of treatment for several days.

Interpretation of the results of a biochemical blood test

New generation laboratory analyzers are able to provide results of the study within two hours after blood sampling. As a rule, the patient receives the results within 2-3 days in the form of a printed or electronic table, which lists the studied indicators, their values ​​and reference (average) normal ranges. Different laboratories offer different amounts of data, in the same article the most commonly studied blood parameters will be described.

Proteins

	Designation	Norma (women)	Norma (men)	Units
Albumin	ALB	< 14 years: 38-54 14-60 years: 35-50 > 60 years: 34-38		g/l
Glycated hemoglobin	HbA1c, A1c, glycosylated hemoglobin	< 5.7		%
Total protein	TP, TProt, Serum	< 1 year: 47-72 1-4 years: 61-75 5-7 years: 52-78 8-15 years: 58-76 > 15 years: 64-83		g/l
C-reactive protein	CRP, SRP	< 0.5		g/l
Iron-binding capacity of serum	TIBC, IBC, OJSS	45.3-77.1		µmol/l
Myoglobin	Myoglobin	12–76	19–92	µg/l
Transferrin	Tf	2. 2-2.4	2–4	g/l
Ferritin	Ferritin	13-150	30-400	µg/l

Total protein characterizes the state of protein metabolism and reveals dysproteinemia (change in the quantitative ratio of protein fractions in blood serum). Decreased values ​​may indicate malnutrition, liver disease, burns, trauma, and surgery, while elevated values ​​may indicate an infectious disease, non-infectious hepatitis, autoimmune disease, dehydration, or may be caused by diarrhea and vomiting.

Protein albumin occupies up to 65% of the blood plasma volume, is produced by the liver and performs the most important function of transporting many biologically active substances. The reasons for the decrease in albumin concentration coincide with those for the total protein. The value increases quite rarely, for example, with dehydration, hemoconcentration, or as a result of taking anabolic steroids.

The iron protein myoglobin is being investigated primarily for the early diagnosis of myocardial infarction. A high concentration of myoglobin may indicate myocardial infarction, heart failure, acute kidney injury, the effects of thermal burns, electric shock. Low myoglobin accompanies the course of rheumatoid arthritis and poliomyelitis.

The value of glycated or glycosylated hemoglobin is very important for patients with diabetes mellitus, and is also used for its diagnosis. Glycated hemoglobin gives an idea of ​​the average level of glucose in the blood over a long period of time (1–2 months). If the concentration of this protein fraction does not exceed 5.7% of the total volume of hemoglobin in the blood, then we can speak of a compensated state. Values ​​in the range of 5.7–6.4% indicate a risk of developing diabetes mellitus, above 6.4% indicate severe decompensated diabetes.

C-reactive protein acts as an indicator of the inflammatory process in the body. Exceeding the threshold of 0.5 g/l indicates acute inflammation or malignancy. Also, this parameter is important for evaluating the effectiveness of antibacterial and anti-inflammatory therapy.

Investigated values ​​of transferrin , ferritin and iron-binding capacity of serum allow diagnosing the pathology of iron metabolism in the blood. Transferrin is the main carrier of iron, an increase in its concentration, as a rule, indicates the development of iron deficiency anemia, and a decrease indicates infections, cirrhosis of the liver, anemia of a different etiology, or protein starvation. With iron deficiency anemia, ferritin, on the contrary, decreases, and its increase indicates inflammatory processes, liver disease, or oncopathology.

Lipids

	Designation	Norma (women)	Norma (men)	Units
Triglycerides	TRIG	< 15 years old: 0. 40–1.48 15–30 years old: 0.4–1.63 30–55 years old: 0.44–2.63 > 55 years old: 0.62–2.71	< 15 years old: 0.34-1.41 15-30 years old: 0.45-2.81 30-55 years old: 0.56-3.61 > 55 years old: 0.65-3.29	mmol/l
Total cholesterol	CHOL	5.2		mmol/l
HDL cholesterol	HDL, HDL-C	1.03–1.55		mmol/l
LDL cholesterol	LDL, LDL-C	0–3.3		mmol/l

Total cholesterol is used to detect primary and secondary disorders of lipid metabolism, assess the likelihood of developing atherosclerosis, and also to evaluate the effectiveness of the treatment of atherogenic disorders of lipid metabolism. A decrease in the value is caused by cachexia, starvation, malabsorption, severe acute diseases, liver failure, hyperthyroidism, and an increase is caused by primary and secondary dyslipoproteinemia. Dangerous consequences of low cholesterol are psychophysiological disorders and reproductive dysfunction, high – diabetes mellitus and atherosclerosis. Biochemical blood test for triglycerides (products of carbohydrate metabolism in the liver) pursues the same tasks, the reasons for the increase and decrease in their concentration also coincide with total cholesterol.

High-density lipoprotein cholesterol and low-density lipoprotein (HDL-C and LDL-C, respectively) are examined and interpreted in combination with total cholesterol and triglycerides for a more accurate diagnosis. HDL-C increases with primary biliary cirrhosis, hepatitis, alcoholism, or its increase may be genetically determined. In patients with atherosclerosis, decompensated diabetes mellitus, chronic kidney disease, cholestasis, the value of HDL-C decreases. Low-density lipoproteins are involved in the processing and excretion of fats, a decrease in their concentration may indicate the development of chronic anemia, Raynaud’s syndrome or myeloma, and an increase in hypothyroidism, nephrotic syndrome, diabetes mellitus, porphyria, Cushing’s syndrome, the risk of atherosclerosis.

Carbohydrates

Glucose is the main source of energy for all cells and tissues of the human body and, in particular, its only source for the brain. The value of glucose in the results of biochemical analysis reflects the level of sugar in the blood. If this value is increased, then there is a risk of developing diabetes mellitus, damage to the central nervous system, and hormonal disorders. Glucose “falls” with the formation of tumors in the pancreas, with liver and adrenal insufficiency, hypothyroidism, malnutrition, or due to insulin intake.

The value of fructosamine reflects the fluctuation in blood glucose levels during the 2-3 weeks prior to the test. If its concentration exceeds 280–285 µmol / l, then the doctor considers the likelihood of developing diabetes.

Inorganic substances and vitamins

	Designation	Norma (women)	Norma (men)	Units
Vitamin B12		208–963.5		pg/ml
Iron	Fe, IRON	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 9-30	< 2 years: 7-18 2-14 years: 9-22 > 14 years: 11-31	µmol/l
Potassium	K	3.5–5		mmol/l
Calcium	Ca	2.25–2.5		mmol/l
Magnesium	Mg	0.75–1.25		mmol/l
Sodium	Na	136-145		mmol/l
Phosphorus	P	< 2 years old: 1. 45–2.16 2–12 years old: 1.45–1.78 12–60 years old: 0.87–1.45 > 60 years old: 0.90–1.32	< 2 years: 1.45-2.16 2-12 years: 1.45-1.78 12-60 years: 0.87-1.45 > 60 years: 0.74-1.2	mmol/l
Chlorine	Cl	98-107		mmol/l

Vitamin B12 in the human body is involved, in particular, in the production of red blood cells. High levels of this vitamin can indicate liver disease, kidney disease, or leukemia. Diseases of parasitic etiology, inflammatory processes in the gastrointestinal tract and adherence to a vegetarian (vegan) diet, on the contrary, lead to a decrease in the level of vitamin B12 in the blood.

In one of the previous paragraphs it was mentioned that iron takes part in the process of transporting oxygen. Its deficiency is usually explained by malnutrition or metabolic disorders, and its excess – by functional disorders of the intestine.

Potassium is responsible for the regulation of water balance and normalizes the heart rhythm. Potassium deficiency occurs due to malnutrition or malnutrition, vomiting, renal failure, Cushing’s syndrome, osmotic diuresis, chronic kidney disease, and also accompanies long-term use of steroid drugs. Potassium also increases with acute dehydration, extensive injuries and burns, chronic adrenal insufficiency, diabetic coma, or as a result of taking potassium-sparing diuretics.

Calcium is involved in the formation of bone tissue, it is extremely important for the normal functioning of muscles, nerves, heart muscle and blood vessels. Low blood calcium values ​​indicate vitamin D deficiency, functional kidney disease, pancreatitis, impaired magnesium metabolism, or hypoparathyroidism. An increase in calcium levels accompanies hyperparathyroidism or is a symptom of oncopathology.

Magnesium performs the function of intracellular metabolism and transmission of impulses from nerve endings to muscles. Malnutrition, malabsorption, prolonged diarrhea, colitis, enterocolitis and dyspepsia reduce the concentration of magnesium in the blood. Functional disorders of the kidneys, hypothyroidism, lactic acidosis and neoplasms lead to its increase.

Along with magnesium, sodium , also involved in calcium metabolism, is responsible for the transmission of impulses to the muscles. The reason for the decrease in sodium can be hypothyroidism, Addison’s disease, diabetes mellitus, kidney and gastrointestinal tract diseases, congestive heart failure, taking gentamicin, less often – Parkon’s syndrome or hypercalciuria. High levels of sodium in the results of biochemistry indicate dehydration, oversaturation of the body with salts, diabetes insipidus or kidney disease with oliguria.

Normal functioning of the nervous and musculoskeletal systems is impossible without a sufficient amount of phosphorus in the body. The content of phosphorus in the blood increases with hypoparathyroidism, an excess of vitamin D, rhabdomyolysis, bone diseases or improper diet, less often with acromegaly. On the other hand, hypovitaminosis D, hyperparathyroidism, kidney transplantation, intravenous glucose infusions, respiratory alkalosis cause a decrease in the concentration of phosphorus in the blood.

Chlorine performs the functions of maintaining the acid-base balance of the blood and osmotic pressure. The most obvious causes of a decrease in chlorine levels are profuse sweating, vomiting, diarrhea, incorrect treatment with diuretics, less commonly, a decrease is caused by nephrotic syndrome and hypokalemic metabolic syndrome. An excess of chlorine in the blood can be a consequence of dehydration, swelling, alkalosis and decompensation of cardiac activity.

Example of blood chemistry results

Low molecular weight nitrogenous substances

	Designation	Norma (women)	Norma (men)	Units
Creatinine	CREA	53–97	62-115	µmol/l
Uric acid	UA	< 14 years: 120-320 > 14 years: 150-350	< 14 years: 120-320 > 14 years: 210-420	µmol/l
Urea	UREA	2. 2-6.7	3.8–7.3	mmol/l

Urea and creatinine are studied in combination, their values ​​reflect the functional state of the patient’s kidneys, in particular, the degree of impairment of filtration and excretory functions. High values ​​indicate kidney problems, but may be due to excessive exercise, a high-protein diet, prolonged fasting, or thyroid disease. Low urea values ​​may be due to a low protein diet, pregnancy, and liver disease.

The level of uric acid as an auxiliary parameter reflects the body’s ability to remove waste products from the processes of nucleic acid and purine metabolism. It is of particular diagnostic interest in patients with gout. The main causes of increased uric acid are gout and alcoholism, less often – the pathology of the kidneys and liver. Low values ​​of uric acid in the results of a biochemical blood test are much less common and usually indicate malnutrition or malnutrition.

Pigments

Yellow pigment bilirubin begins to accumulate in the blood in diseases and hereditary pathologies of the liver, biliary tract, for example, Gilbert’s syndrome. Indirect bilirubin can also be elevated in some anemias and malaria.

Enzymes

Liver enzyme with an unpronounceable name alanine aminotransferase is involved in amino acid metabolism. The indicator increases with myocardial infarction, acute hepatitis A and B, and other liver diseases.

Enzyme amylase is produced by the salivary glands and pancreas and is responsible for the digestion of carbohydrates. Exceeding the norm by 3-5 times may indicate acute appendicitis, peritonitis, stomach and duodenal ulcers, cholecystitis. In acute pancreatitis or exacerbation of its chronic form, the value of amylase increases by 10–30 times. An increased value of pancreatic amylase allows timely detection of complications of operations on the abdominal organs and diseases of the pancreas.

The concentration of the enzyme aspartate aminotransferase in human blood increases greatly in case of damage to the liver or heart muscle, due to alcohol abuse, the indicators can increase two times relative to the norm.

High values ​​of the enzyme gamma-glutamyltransferase are observed in patients with acute hepatitis, extra- and intrahepatic cholestasis, alcoholism, pancreatic and prostate cancer, primary liver tumors.

An increase in the concentration of creatine kinase in the blood may indicate myocardial infarction, muscle damage of various origins, and renal failure. Lactate dehydrogenase is increased in diseases of the cardiovascular system, liver and kidneys, as well as in pregnant women. High values ​​of lipase are observed in patients with acute pancreatitis, intestinal infarction, biliary colic, wounds, fractures, and breast cancer. The metabolism of phosphorus in the body is directly related to the content of alkaline phosphatase – its increase accompanies acute viral and alcoholic hepatitis, liver cirrhosis, mononucleosis, liver cancer or liver metastases. Cholinesterase decreases in liver cirrhosis, liver failure, hepatitis, myocardial infarction. The value of cholinesterase is also indicative for patients taking muscle relaxants.

Analysis norms. Analysis decoding. Reference values, interval.

“Norm” and “pathology” in laboratory diagnostics.

This article describes what the test norms are, how tests are deciphered, why it is not modern to say “norm”, and what are the reference values ​​​​and the reference interval.

Standards for interpretation of tests. Concept of reference values ​​and reference interval.

The information obtained in the course of laboratory analysis is based on the detection and / or measurement in clinical samples (biomaterial) of patients of certain components – analytes, functionally or structurally related to a specific human organ or organ system. The most important component of any laboratory research is the interpretation of its result. Establishing the difference between the norm of analyzes and pathology plays a key role in assessing the data obtained. In practice, this is not difficult to do with a clear deviation of laboratory parameters from the values ​​taken as the norm. However, it is not always easy to divide most of the results of laboratory tests into “normal” and “pathology”, and therefore, in order to interpret them, a comparison of the data obtained with the indicators established as the norm is required.

Normal test values ​​(norm) are values ​​found in healthy people. However, in the groups of the latter, they can have different values, that is, the norm is individual. This is due both to the individual physiological characteristics of the human body (characteristics of metabolism, circadian biological rhythms, the functional state of certain organs and their systems), and differences in gender, age, and physiological state. For example, during pregnancy, many biochemical parameters of a woman’s body change, therefore, appropriate individual norms are determined for pregnant women.

Normal laboratory values ​​are determined in experimental clinical studies based on the results of measurements of the analyte under investigation in a large population of healthy people, specially selected and grouped by age, sex or other biological and other factors. The data obtained lead to the mean value, taking into account the statistically possible standard deviations of its value. In this regard, it is more correct to speak not about the “norm” of a laboratory indicator, but about the range in which normal (reference) values ​​are located. Therefore, at present, the term “norm”, which has already become familiar in assessing the results of a laboratory study, is used less often. Instead, they talk about reference (reference) values ​​ and the results obtained for a particular patient are compared with the so-called reference interval (range) . This term is more accurate, because it gives an idea of ​​the lower and upper limits of the norm of a laboratory indicator, possible, statistically significant limits of fluctuation (deviation) of its value and, at the same time, emphasizes the relativity of these data, the possibility of applying only to a certain group of people.

Explanation of analyzes. Norm or pathology?

When establishing the reference range, mathematical and statistical approaches are used, according to which the values ​​of the results of laboratory studies of a certain analyte of 95% of healthy people fall within the established interval. Accordingly, for 5% – the values ​​of the analyzed indicators are outside the established range. In other words, in 5% of cases in healthy people, “abnormal” laboratory parameters are detected, which should be taken into account when deciphering the analysis. This is explained by a number of reasons.

First, the division of the biological population of people into “sick” and “healthy” according to many laboratory parameters is very conditional. Being statistical data, the limits of normal laboratory values ​​may vary. Therefore, it happens that in healthy people certain indicators that are “normal” for them are not ultimately “normal” for most others, and therefore do not fall into the range of generally accepted reference values. In this case, the limits of the reference range cannot serve as absolute indicators of health or disease.

On the other hand, often the disease develops imperceptibly, manifesting itself as a gradual transition from small deviations in the values ​​of laboratory parameters to their higher values ​​as dysfunction increases and the severity of the disease progresses. In this regard, when deciphering the analyzes in interpreting the results of laboratory tests, it becomes very important for the clinician to assess the dynamics of changes in a particular laboratory indicator in a particular patient. In doubtful cases, the main criterion for the presence or absence of a disease is the clinical symptomatology or the degree of its severity. In the presence of symptoms of the disease, additional laboratory tests are used for diagnosis using highly sensitive and specific tests that most pronouncedly change their values ​​against the background of the suspected disease.

Secondly, “healthy” and “sick” people actually belong to two different populations, and when these populations are mixed together, it is almost impossible to recognize each of them in the total mass. In addition, in different patients, the same indicator can not only take on different values, but also overlap the values ​​of this indicator in healthy people. Moreover, for different indicators, different diseases, different groups of patients, the value of such a “crossover” can vary greatly: from too small, which can be neglected, to very significant, when a special approach and careful analysis of all data is required to classify the result as “normal” or “pathological”. The latter is extremely important to take into account when evaluating the results of laboratory tests, since in this case not all values ​​that are outside the normal range will indicate the presence of pathology. The range of values ​​in which the laboratory parameters of “sick” and “healthy” individuals overlap is called the zone of uncertainty, or the “gray zone”. It exists for a range of laboratory procedures, but is most commonly found in enzyme immunoassay results. If the result falls into the “gray zone”, it cannot be unequivocally regarded either as a norm or as a pathology and is considered as doubtful. In such a case, the patient is usually advised to repeat the diagnostic study 2 to 4 weeks after receiving an indeterminate result.

And, finally, not always an indicator lying in the reference interval can be considered normal, since the range of many of them is quite wide. For example, the normal value of hematocrit (Ht) in men varies from 42 to 52%. Massive blood loss can lead to a drop in this indicator from 52 to 42%, while the value of 42% remains within the range of reference values, and therefore may not cause alarm for doctors. However, in a certain situation, for a particular patient, such a decrease in hematocrit can be not only clinically significant, but also critical.

Therefore, results within the reference range are not always normal. And, on the contrary, the results that go beyond the reference values ​​are not always pathology, but only a significant prognostic sign that can signal a possible pathological process. In this regard, in laboratory diagnostics, the approach is becoming more widespread, when the most significant and adequate reference values ​​for each individual patient should be considered stable results of his laboratory studies obtained over several years. Already at present, experts around the world are inclined to believe that it is necessary to “lower” the significance of reference intervals, moving away from interpreting them as some kind of “absolute” criterion for evaluating a laboratory result. This circumstance in no way reduces the importance of laboratory research. They remain the most important tool for diagnosing pathological conditions, monitoring the course of diseases, identifying the preclinical stage of diseases during screening examinations, and also largely determine the further tactics of diagnostic procedures and treatment decisions. However, this approach directs the clinician to a more cautious use of reference values ​​in the assessment of “normal” and “pathological” results, indicating the need for their interpretation, taking into account possible biological variation in the population, taking into account the data of the clinical picture and other types of studies in the aggregate, and as well as those factors that may influence the results of laboratory tests.

Reference ranges

Reference values ​​are currently established for many laboratory parameters. The results of some types of research are given to the patient in the form of “yes” or “no”. This type of research is qualitative. For example, a positive result for antibodies to a specific infection indicates the presence of these antibodies in the patient’s blood and may indicate infection. In the case when the study was quantitative, the result is issued as a numerical value, indicating on the form the units of measurement and the corresponding reference range. For example, the results of a biochemical study to determine the level of C-reactive protein (CRP), which is a marker of inflammation, may look like this: 0.4 mg / l, reference values: 0 – 6 mg / l. From the above example, it can be seen that the result obtained is within the established reference range. For most laboratory parameters, the range of reference values ​​is indicated taking into account the patient’s gender and / or his belonging to a certain age group. For example, the reference values ​​​​of serum creatinine for children under 1 year old are 18 – 35 µmol / l, for children from one to 14 years old – 27 – 62 µmol / l, and for people over 14 years old – 62 – 115 µmol / l for male and 53 – 97 µmol/l for females.

The influence of age and sex on the range of reference values ​​is significant for many laboratory tests. For example, the concentration of alkaline phosphatase, a key enzyme secreted by bone tissue cells, increases in proportion to the rate of formation of new bone cells. Therefore, in children and adolescents, a high level of this enzyme is not only normal, but also desirable, since it is associated with the active formation and growth of bones. On the contrary, a high level of alkaline phosphatase in an adult may indicate developing osteoporosis, metastases of bone tumors, or other pathological processes. The exception is pregnant women, who are characterized by a physiological increase in the activity of this enzyme, especially in the third trimester of pregnancy.

Why can reference ranges differ from laboratory to laboratory?

Different diagnostic laboratories use different types of laboratory equipment to perform analysis, for example, biochemical and immunochemical analyzers, the range of which is currently very wide, work with reagents from different manufacturers, and in addition, they may use different research methods than other laboratories . In this regard, each laboratory indicates on the form of results its ranges of reference values, when establishing which, of course, it is guided by generally accepted standards, but taking into account the individual characteristics of its work: the specifics of the equipment used, the methods of analysis used and units of measurement. That is why the ranges of reference values ​​for the same laboratory test may vary according to the data of different diagnostic laboratories, and there is no such thing as a “single” reference range. When evaluating the results of laboratory tests, the attending physician should first of all refer to the range of reference values ​​indicated on the form of the laboratory in which the analysis was performed. In order for the results to be interpreted correctly and comparable, especially in the case of repeated studies, for example, when monitoring therapy or dynamic assessment of the patient’s condition, it is advisable to conduct studies using the same method, in the same laboratory and, if possible, ceteris paribus.

Factors affecting laboratory results

Modern methods of clinical laboratory research are characterized by high sensitivity and specificity, and therefore their results, reflecting the patient’s health, can serve as the basis for making important clinical decisions by the attending physician. At the same time, both clinicians and patients should understand that there are a number of non-pathological factors that can, to a certain extent, influence the results of laboratory tests, distorting the objective picture of the patient’s health. Some of these factors can only be controlled by the efforts of laboratory specialists, minimizing their possible negative impact on the final result of the laboratory study. Among such factors, for example, the conditions and method of taking biological material, delivery and storage of samples, the correctness of their identification in the laboratory. However, to minimize the negative impact of many other factors that affect the accuracy of the final result of a laboratory test, only the patient himself or his attending physician, who must inform the patient about the correct preparation for a certain type of laboratory test, can. Compliance with the doctor’s instructions will allow the analysis to be as close as possible to the general requirements, for example, the need to donate blood on an empty stomach, and thereby bring the results of the study as close as possible to the reference ones for this group of patients.

What factors can influence the results of laboratory tests? First of all, it should be noted the sensitivity of many laboratory tests to the time interval associated with the patient’s intake of food in general or individual products in particular, as well as the peculiarities of his eating behavior, for example, diet (meat or vegetarian), coffee and alcohol consumption. For example, high blood sugar may be related to a recent meal rather than diabetes. Eating shortly before the study will affect the results of lipid profile tests, insulin and C-peptide levels. In this regard, in order to obtain accurate results of the study, it is recommended to donate blood in the morning on an empty stomach, usually not less than 8 and not more than 14 hours after the last meal. On the eve of the study, food overload should be avoided.

High levels of liver enzymes may be due to recent or frequent alcohol use. Caffeine can cause an increase in the concentration of catecholamines and renin in plasma. Smoking sometimes causes a borderline increase in the level of some tumor markers.

Lab test results may be affected by vitamin and nutritional supplements and medications. In this case, the effect of drugs can be multidirectional. They can not only change the physiological processes in the body, but also chemically interfere (interact) with the analyzed analyte under conditions in vitro . An example of the effect of drugs on the physiological level is the increase in liver enzymes under the influence of hepatotoxic drugs. Drugs that affect plasma volume can cause changes in the concentration of proteins, urea nitrogen, iron and calcium. An example of another influence is non-specific binding reactions of certain drug metabolites with individual components of the reaction mixture, for example, polyclonal antibodies in immunoassays, as a result of which an erroneous result can be obtained. In this regard, a patient taking any medications should consult with a doctor about the advisability of conducting a laboratory study while taking medications or the possibility of stopping them before the study.

Among the factors affecting the results of laboratory tests is physical activity. Physical stress leads to a volumetric shift between the vascular bed and the intercellular space, loss of fluid with sweat and, as a result, to a change in the concentration of some analytes: hormones or enzymes. Therefore, visiting, for example, a gym on the eve of a laboratory test is undesirable. Heavy physical activity can cause an increase in the level of certain enzymes (ALT, AST, LDH, creatine kinase), a change in the level of various blood substrates (glucose, urea, etc.), and increase the excretion of protein in the urine. In addition, people who have been actively involved in sports for a long time, such as long-distance running or weightlifting, may have slightly increased levels of testosterone and luteinizing hormone (LH).

A general recommendation to prepare for the test is to rest (preferably sit) for 10 to 20 minutes after arriving at the laboratory before taking blood samples. This is also due to the fact that the results of some laboratory tests can be influenced by the body position of the subject at the time of its conduct, as well as the emotional state of the person before and during the study. So, for example, a change in body position from a lying position to a sitting or standing position causes vasoconstriction, and a change in position from a sitting to a lying position causes a shift of water and electrolytes in the tissue, leading to blood concentration. As a result, serum or plasma levels of total protein, albumin, lipids, iron and calcium change upward.

Emotional stress can cause significant increases in cortisol, ACTH and glucose levels. Among other things, stress is combined with an increase in the concentrations of albumin, fibrinogen, insulin, lactate and cholesterol. That is why it is so important, if possible, to exclude psycho-emotional stress on the eve of the study and try not to worry in the process of taking a biological sample.

Temporary changes in some laboratory parameters may be caused by physiotherapy and instrumental examinations (eg, prostate biopsy before PSA testing). In such cases, it is recommended to postpone the laboratory examination for several days.

For a number of hormonal studies, it is important to take into account the phase of the menstrual cycle in women, and therefore you should check with your doctor in advance the optimal days for blood donation to determine the level of FSH, LH, inhibin B, prolactin, progesterone, estradiol and some other hormones.

The time of day during sampling is especially important when cortisol, thyroid stimulating hormone (TSH) and some other analytes need to be measured. At the same time, it should be borne in mind that the reference values ​​- the boundaries of the “normal” laboratory parameters, usually reflect the statistical data obtained under standard conditions when taking blood in the morning.

Thus, there are a number of reasons why the results of the analysis may fall outside the established range of reference values, even if the person is absolutely healthy. Therefore, if the patient is aware of any special circumstances that could affect the results of the studies, they should be reported to their doctor. Don’t expect him to figure them out on his own. After all, a result that does not correspond to the “norm” is not necessarily a sign of a disease, and therefore the doctor needs to understand its possible cause. It is possible that this is just the case when the result obtained falls into those very statistically significant 5%, in which the laboratory parameters of healthy people are outside the reference range. Sometimes some “abnormal” results can go back to normal on their own, especially if they were on the border of the reference values. In addition, there are not many diseases that can be diagnosed with just one single study.

The above examples show that in order to adequately evaluate the results of laboratory tests, as well as to make the right clinical decisions for the patient on the basis of them, a comprehensive approach is needed that takes into account all the variety of factors that can affect the accuracy and correctness of the data obtained. . Clinical conclusions and decisions based on the results of laboratory analyzes will be correct only if the various preanalytical and analytical factors are sufficiently standardized and fully taken into account. It is very important that the patient be able to follow all the necessary recommendations for preparing for laboratory tests, and the attending physician, interpreting the data obtained, would take into account the possible impact on the result of the study of non-pathological factors that occurred, and also comprehensively evaluate the results, taking into account the clinical picture and data from other types research.

Laboratory diagnostics specialists, if necessary, are always ready to answer questions on the results obtained, provide additional special information and explanations or consult in complex cases.

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