Liver function test normal levels: Liver function tests – Mayo Clinic

14.06.202128.07.2023 by alexxlab

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Liver Function Test – About, Normal Range, Preparation, Test Results & More

what is a liver function test?

It is a group of tests that gives a statement on the health of a patient’s liver. It determines the health of the liver by evaluating the level of liver enzymes, proteins or bilirubin in the blood. The main tests in the liver function tests are prothrombin time, APTT, albumin, bilirubin.

A liver function test is recommended for the following reasons:

To screen for any infections such as hepatitis C in the liver

If you are consuming any medications that might have a side effect on the liver functions

To monitor an already existing liver disease and its status during treatment like liver cancer

If you have any symptoms of any liver problems or liver disease

Planning for pregnancy

symptoms of liver problems:

Jaundice fever – skin and eyes turn yellowish

Swelling and pain of the abdominal

Swelling of legs and ankles

Itching of the skin

Dark colour Urine

Stool is either bloody, tar-coloured or pale

Fatigue

Queasiness or vomiting

Appetite loss

Easily getting bruised

causes of liver problem:

There may be many liver damage causes. Some of them are:

Infection

Immune system abnormality

Genetics

Cancer

Habits such as excessive alcohol intake

why do i need liver function test?

The liver is a vital organ of the human body and liver functions play a vital role in the overall health of your body.

A liver function test helps in determining the condition and health of your liver in order for it to perform the following liver functions efficiently.

what is the function of a liver?

Cleanses your blood by removing contaminants eliminating liver infections

Helps in converting nutrients from your food intake

Stores vitamins and minerals in your body

Regulates blood clot

Produces enzymes, proteins and bile

Produces infection fighting factors

Removes bacteria from the blood

Processes harmful substances from the body

Helps in balancing hormones

With so much liver functions, a problem caused in the liver can cause life-threatening diseases to the person.

what do my test results mean?

The most common blood test taken for liver function test is aminotransferases.

If your liver function test results range between 7-56 units/litre for ALT and 10-40 got AST, your liver function is normal. Anything outside the liver function test normal range means there might be some liver problems or liver infection and needs to be diagnosed and treated.

how is liver function test done?

The liver function test is like any other blood test. It may be taken at a hospital, clinic or specialised testing facility. You can administer the test by checking if the following steps are done:

Your skin will be cleaned by the blood test technician to prevent any substances on your skin to avoid contamination of the test.

They will wrap your arm with some sort of pressure device to make the veins more visible. They will then insert the needle into the vein to draw enough blood samples for the test.

Once the blood is drawn, they will cover the pierced area to avoid any infection and will send the blood samples for testing to the laboratory.

does liver function test pose any risk?

Blood tests are a very common routine to check several diseases and diagnosis like the liver disease. The rare cases of risks that might happen while giving a blood sample are:

Internal bleeding under the skin

excessive bleeding

fainting due to weakness after blood withdrawal

Infection

how do i prepare for the test?

You will be guided by the doctor with instructions to follow before taking the tests. You may have to avoid certain foods and medicines before the test as they might affect the levels of enzymes and proteins present in your blood.

how can we help?

Do you find yourself searching for “Liver function test near me” on google? Worry no more. We now provide services for home liver function test. If you have noticed any symptoms of a liver problem or liver infection and your doctor can recommended you to take this tests, all you have to do is contact us!

We will have a health care expert sent to your house and do the necessary procedures. The samples will be sent for testing and you will receive your liver function test report at your doorstep.

at-home lipid liver function test in top location include:

Bangalore, Delhi-NCR, Chennai, Hyderabad, Kolkata, Pune, Lucknow, Indore.

liver function test (lft) cost 2022 in india

The average cost of at home Liver Function Test in India is Rs.600, Book from Portea to get tested at your home

Understanding results ofLiver Function

SGOT	The normal range for the AST test is 10 to 34 IU/L (international units per liter)
GGT	The normal range for GGT in blood is 0 to 51 international units/liter.
Total Protein	The total protein is between 6 and 8.3 gm/dL (grams per deciliter)
Albumin	The typical value for albumin is 3.4 to 5.4 g/dL of blood
Bilirubin	In an older child or adult, normal values of direct (conjugated) bilirubin are from 0 to 0. 3 milligrams per deciliter (mg/dL). Normal values of total bilirubin (direct and indirect) are from 0.3 to 1.9 mg/dL. In a newborn, higher bilirubin is normal due

‘*A Reference range is a set of values which helps the healthcare professional to interpret a medical test. It may vary with age, gender, and other factors. Reference ranges may also vary between labs, in value & units depending on instruments used and method of establishment of reference ranges’

References

https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/diagnosing-liver-disease/
https://medlineplus.gov/liverfunctiontests.html
https://www.labtestsonline.org.au/learning/test-index/liver-function
https://www.drugabuse.gov/news-events/nida-notes/2013/12/medications-treat-opioid-addiction-do-not-impair-liver-health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609680/

Special Considerations in Interpreting Liver Function Tests

DAVID E. JOHNSTON, M.D.

A number of pitfalls can be encountered in the interpretation of common blood liver function tests. These tests can be normal in patients with chronic hepatitis or cirrhosis. The normal range for aminotransferase levels is slightly higher in males, nonwhites and obese persons. Severe alcoholic hepatitis is sometimes confused with cholecystitis or cholangitis. Conversely, patients who present soon after passing common bile duct stones can be misdiagnosed with acute hepatitis because aminotransferase levels often rise immediately, but alkaline phosphatase and γ-glutamyltransferase levels do not become elevated for several days. Asymptomatic patients with isolated, mild elevation of either the unconjugated bilirubin or the γ-glutamyltransferase value usually do not have liver disease and generally do not require extensive evaluation. Overall hepatic function can be assessed by applying the values for albumin, bilirubin and prothrombin time in the modified Child-Turcotte grading system.

The commonly used liver function tests (LFTs) primarily assess liver injury rather than hepatic function. Indeed, these blood tests may reflect problems arising outside the liver, such as hemolysis (elevated bilirubin level) or bone disease (elevated alkaline phosphatase [AP] level).

Abnormal LFTs often, but not always, indicate that something is wrong with the liver, and they can provide clues to the nature of the problem. However, normal LFTs do not always mean that the liver is normal. Patients with cirrhosis and bleeding esophageal varices can have normal LFTs. Of the routine LFTs, only serum albumin, bilirubin and prothrombin time (PT) provide useful information on how well the liver is functioning.

The general subject of LFTs^1,2 and the differential diagnosis of abnormal LFTs in asymptomatic patients^3–5 have been well reviewed. This article discusses some common pitfalls in the interpretation of LFTs. Hints for interpreting these tests are presented in Table 1.

Situation	Comments
Mildly elevated ALT level (less than 1.5 times normal)	ALT value could be normal for gender, ethnicity or body mass index.
Mildly elevated ALT level (less than 1.5 times normal)	Consider muscle injury or myopathy.
Alcoholic hepatitis	Laboratory values can appear cholestatic, and symptoms can mimic cholecystitis.
Alcoholic hepatitis	Minimal elevations of AST and ALT often occur.
AST level greater than 500 U per L	The AST elevation is unlikely to result from alcohol intake alone.
AST level greater than 500 U per L	In a heavy drinker, consider acetaminophen toxicity.
Common bile duct stone	Condition can simulate acute hepatitis
Common bile duct stone	AST and ALT become elevated immediately, but elevation of AP and GGT is delayed.
Isolated elevation of GGT level	This situation may be induced by alcohol and aromatic medications, usually with no actual liver disease.
Isolated elevation of AP level (asymptomatic patient with normal GGT level)	Consider bone growth or injury, or primary biliary cirrhosis.
	AP level rises in late pregnancy.
Isolated elevation of unconjugated bilirubin level	Consider Gilbert syndrome or hemolysis.
Low albumin level	Low albumin is most often caused by acute or chronic inflammation, urinary loss, severe malnutrition or liver disease; it is sometimes caused by gastrointestinal loss (e.g., colitis or some uncommon small bowel disease).
Low albumin level	Normal values are lower in pregnancy.
Blood ammonia level	Blood ammonia values are not necessarily elevated in patients with hepatic encephalopathy.
Blood ammonia level	Determination of blood ammonia levels is most useful in patients with altered mental status of new onset or unknown origin.

Markers of Hepatocellular Injury

The most commonly used markers of hepatocyte injury are aspartate aminotransferase (AST, formerly serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT, formerly serum glutamate-pyruvate transaminase [SGPT]). While ALT is cytosolic, AST has both cytosolic and mitochondrial forms.

Hepatocyte necrosis in acute hepatitis, toxic injury or ischemic injury results in the leakage of enzymes into the circulation. However, in chronic liver diseases such as hepatitis C and cirrhosis, the serum ALT level correlates only moderately well with liver inflammation. In hepatitis C, liver cell death occurs by apoptosis (programmed cell death) as well as by necrosis. Hepatocytes dying by apoptosis presumably synthesize less AST and ALT as they wither away. This probably explains why at least one third of patients infected with hepatitis C virus have persistently normal serum ALT levels despite the presence of inflammation on liver biopsy.^6,7 Patients with cirrhosis often have normal or only slightly elevated serum AST and ALT levels. Thus, AST and ALT lack some sensitivity in detecting chronic liver injury. Of course, AST and ALT levels tend to be higher in cirrhotic patients with continuing inflammation or necrosis than in those without continuing liver injury.

As markers of hepatocellular injury, AST and ALT also lack some specificity because they are found in skeletal muscle. Levels of these aminotransferases can rise to several times normal after severe muscular exertion or other muscle injury, as in polymyositis,⁸ or in the presence of hypothyroidism, which can cause mild muscle injury and the release of aminotransferases. In fact, AST and ALT were once used in the diagnosis of myocardial infarction.

Slight AST or ALT elevations (within 1. 5 times the upper limits of normal) do not necessarily indicate liver disease. Part of this ambiguity has to do with the fact that unlike the values in many other biochemical tests, serum AST and ALT levels do not follow a normal bell-shaped distribution in the population.⁹ Instead, AST and ALT values have a skewed distribution characterized by a long “tail” at the high end of the scale (Figure 1).⁵ For example, the mean values for ALT are very similar from one population to another, but the degree to which the distribution is skewed varies by gender and ethnicity. The ALT distributions in males and nonwhites (i.e., blacks and Hispanics) tend to have a larger tail at the high end, so that more values fall above the upper limits of normal set for the average population.^10,11

AST and ALT values are higher in obese patients, probably because these persons commonly have fatty livers.¹² ALT levels have been noted to decline with weight loss. ¹³ Depending on the physician’s point of view, the upper limits of normal for AST and ALT levels could be set higher for more obese persons.

Rare individuals have chronically elevated AST levels because of a defect in clearance of the enzyme from the circulation.¹⁴ For both AST and ALT, the average values and upper limits of normal in patients undergoing renal dialysis are about one half of those found in the general population.¹⁵ Mild elevations of ALT or AST in asymptomatic patients can be evaluated efficiently by considering alcohol abuse, hepatitis B, hepatitis C and several other possible diagnoses (Table 2).⁵

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Various liver diseases are associated with typical ranges of AST and ALT levels (Figure 2). ALT levels often rise to several thousand units per liter in patients with acute viral hepatitis. The highest ALT levels—often more than 10,000 U per L—are usually found in patients with acute toxic injury subsequent to, for example, acetaminophen overdose or acute ischemic insult to the liver. AST and ALT levels usually fall rapidly after an acute insult.

Lactate dehydrogenase (LDH) is less specific than AST and ALT as a marker of hepatocyte injury. However, it is worth noting that LDH is disproportionately elevated after an ischemic liver injury.¹⁶

It is especially important to remember that in patients with acute alcoholic hepatitis, the serum AST level is almost never greater than 500 U per L and the serum ALT value is almost never greater than 300 U per L. The reasons for these limits on AST and ALT elevations are not well understood. In typical viral or toxic liver injury, the serum ALT level rises more than the AST value, reflecting the relative amounts of these enzymes in hepatocytes. However, in alcoholic hepatitis, the ratio of AST to ALT is greater than 1 in 90 percent of patients and is usually greater than 2. ¹⁷ The higher the AST-to-ALT ratio, the greater the likelihood that alcohol is contributing to the abnormal LFTs. In the absence of alcohol intake, an increased AST-to-ALT ratio is often found in patients with cirrhosis.

The elevated AST-to-ALT ratio in alcoholic liver disease results in part from the depletion of vitamin B₆ (pyridoxine) in chronic alcoholics.¹⁸ ALT and AST both use pyridoxine as a coenzyme, but the synthesis of ALT is more strongly inhibited by pyridoxine deficiency than is the synthesis of AST. Alcohol also causes mitochondrial injury, which releases the mitochondrial isoenzyme of AST.

Patients with alcoholic hepatitis can present with jaundice, abdominal pain, fever and a minimally elevated AST value, thereby leading to a misdiagnosis of cholecystitis. This is a potentially fatal mistake given the high surgical mortality rate in patients with alcoholic hepatitis.¹⁹

Markers of Cholestasis

Cholestasis (lack of bile flow) results from the blockage of bile ducts or from a disease that impairs bile formation in the liver itself. AP and γ-glutamyltransferase (GGT) levels typically rise to several times the normal level after several days of bile duct obstruction or intrahepatic cholestasis. The highest liver AP elevations—often greater than 1,000 U per L, or more than six times the normal value—are found in diffuse infiltrative diseases of the liver such as infiltrating tumors and fungal infections.

Diagnostic confusion can occur when a patient presents within a few hours after acute bile duct obstruction from a gallstone. In this situation, AST and ALT levels often reach 500 U per L or more in the first hours and then decline, whereas AP and GGT levels can take several days to rise.

Both AP and GGT levels are elevated in about 90 percent of patients with cholestasis.²⁰ The elevation of GGT alone, with no other LFT abnormalities, often results from enzyme induction by alcohol or aromatic medications in the absence of liver disease. The GGT level is often elevated in persons who take three or more alcoholic drinks (45 g of ethanol or more) per day. ²¹ Thus, GGT is a useful marker for immoderate alcohol intake. Phenobarbital, phenytoin (Dilantin) and other aromatic drugs typically cause GGT elevations of about twice normal. A mildly elevated GGT level is a typical finding in patients taking anticonvulsants and by itself does not necessarily indicate liver disease.^22,23

Serum AP originates mostly from liver and bone, which produce slightly different forms of the enzyme. The serum AP level rises during the third trimester of pregnancy because of a form of the enzyme produced in the placenta. When serum AP originates from bone, clues to bone disease are often present, such as recent fracture, bone pain or Paget’s disease of the bone (often found in the elderly). Like the GGT value, the AP level can become mildly elevated in patients who are taking phenytoin.^22,23

If the origin of an elevated serum AP level is in doubt, the isoenzymes of AP can be separated by electrophoresis. However, this process is expensive and usually unnecessary because an elevated liver AP value is usually accompanied by an elevated GGT level, an elevated 5′-nucleotidase level and other LFT abnormalities.

In one study,²⁴ isolated AP elevations were evaluated in an unselected group of patients at a Veterans Affairs hospital. Most mild AP elevations (less than 1.5 times normal) resolved within six months, and almost all greater elevations had an evident cause that was found on routine clinical evaluation.

Persistently elevated liver AP values in asymptomatic patients, especially women, can be caused by primary biliary cirrhosis, which is a chronic inflammatory disorder of the small bile ducts. Serum antimitochondrial antibody is positive in almost all of these patients.

Indicators of How Well the Liver Functions

BILIRUBIN

Bilirubin results from the enzymatic breakdown of heme. Unconjugated bilirubin is conjugated with glucuronic acid in hepatocytes to increase its water solubility and is then rapidly transported into bile. The serum conjugated bilirubin level does not become elevated until the liver has lost at least one half of its excretory capacity. Thus, a patient could have obstruction of either the left or right hepatic duct without a rise in the bilirubin level.

Because the secretion of conjugated bilirubin into bile is very rapid in comparison with the conjugation step, healthy persons have almost no detectable conjugated bilirubin in their blood. Liver disease mainly impairs the secretion of conjugated bilirubin into bile. As a result, conjugated bilirubin is rapidly filtered into the urine, where it can be detected by a dipstick test. The finding of bilirubin in urine is a particularly sensitive indicator of the presence of an increased serum conjugated bilirubin level.

In many healthy persons, the serum unconjugated bilirubin is mildly elevated to a concentration of 2 to 3 mg per dL (34 to 51 μmol per L) or slightly higher, especially after a 24-hour fast. If this is the only LFT abnormality and the conjugated bilirubin level and complete blood count are normal, the diagnosis is usually assumed to be Gilbert syndrome, and no further evaluation is required. Gilbert syndrome was recently shown to be related to a variety of partial defects in uridine diphosphate-glucuronosyl transferase, the enzyme that conjugates bilirubin.²⁵

Mild hemolysis, such as that caused by hereditary spherocytosis and other disorders, can also result in elevated unconjugated bilirubin values, but hemolysis is not usually present if the hematocrit and blood smear are normal. The presence of hemolysis can be confirmed by testing other markers, such as haptoglobin, or by measuring the reticulocyte count.

Severe defects in bilirubin transport and conjugation can lead to markedly elevated unconjugated bilirubin levels, which can cause serious neurologic damage (kernicterus) in infants. However, no serious form of liver disease in adults causes elevation of unconjugated bilirubin levels in the blood without also causing elevation of conjugated bilirubin values.

When a patient has prolonged, severe biliary obstruction followed by the restoration of bile flow, the serum bilirubin level often declines rapidly for several days and then slowly returns to normal over a period of weeks. The slow phase of bilirubin clearance results from the presence of delta-bilirubin, a form of bilirubin chemically attached to serum albumin.²⁶ Because albumin has a half-life of three weeks, delta-bilirubin clears much more slowly than bilirubin-glucuronide. Clinical laboratories can measure delta-bilirubin concentrations, but such measurements are usually unnecessary if the physician is aware of the delta-bilirubin phenomenon.

ALBUMIN

Although the serum albumin level can serve as an index of liver synthetic capacity, several factors make albumin concentrations difficult to interpret.²⁷ The liver can synthesize albumin at twice the healthy basal rate and thus partially compensate for decreased synthetic capacity or increased albumin losses. Albumin has a plasma half-life of three weeks; therefore, serum albumin concentrations change slowly in response to alterations in synthesis. Furthermore, because two thirds of the amount of body albumin is located in the extravascular, extracellular space, changes in distribution can alter the serum concentration.

In practice, patients with low serum albumin concentrations and no other LFT abnormalities are likely to have a nonhepatic cause for low albumin, such as proteinuria or an acute or chronic inflammatory state. Albumin synthesis is immediately and severely depressed in inflammatory states such as burns, trauma and sepsis, and it is commonly depressed in patients with active rheumatic disorders or severe end-stage malnutrition. In addition, normal albumin values are lower in pregnancy.

PROTHROMBIN TIME

The liver synthesizes blood clotting factors II, V, VII, IX and X. The prothrombin time (PT) does not become abnormal until more than 80 percent of liver synthetic capacity is lost. This makes PT a relatively insensitive marker of liver dysfunction. However, abnormal PT prolongation may be a sign of serious liver dysfunction. Because factor VII has a short half-life of only about six hours, it is sensitive to rapid changes in liver synthetic function. Thus, PT is very useful for following liver function in patients with acute liver failure.

An elevated PT can result from a vitamin K deficiency. This deficiency usually occurs in patients with chronic cholestasis or fat malabsorption from disease of the pancreas or small bowel. A trial of vitamin K injections (e.g., 5 mg per day administered subcutaneously for three days) is the most practical way to exclude vitamin K deficiency in such patients. The PT should improve within a few days.

BLOOD AMMONIA

Measurement of the blood ammonia concentration is not always useful in patients with known or suspected hepatic encephalopathy. Ammonia contributes to hepatic encephalopathy; however, ammonia concentrations are much higher in the brain than in the blood and therefore do not correlate well.²⁸ Furthermore, ammonia is not the only waste product responsible for encephalopathy. Thus, blood ammonia concentrations show only a mediocre correlation with the level of mental status in patients with liver disease. It is not unusual for the blood ammonia concentration to be normal in a patient who is in a coma from hepatic encephalopathy.

Blood ammonia levels are best measured in arterial blood because venous concentrations can be elevated as a result of muscle metabolism of amino acids. Blood ammonia concentrations are most useful in evaluating patients with stupor or coma of unknown origin. It is not necessary to evaluate blood ammonia levels routinely in patients with known chronic liver disease who are responding to therapy as expected.

Grading Liver Function by Child-Turcotte Class

In communicating among themselves, many physicians use the Child-Turcotte class as modified by Pugh, often termed the “Child class,” to convey information about overall liver function and prognosis (Table 3).²⁹ This grading system can be used to predict overall life expectancy and surgical mortality in patients with cirrhosis and other liver diseases.³⁰

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

For elective general abdominal surgery, perioperative mortality is in the neighborhood of several percent for patients who fall into the Child class A, 10 to 20 percent for those in class B and approximately 50 percent for those in class C.³¹ These percentages must be balanced by prognostic considerations when transplantation becomes an option. The presence of cirrhosis by itself is not an indication for liver transplantation, and transplantation is rarely performed in patients who fall into Child class A. For example, the 10-year survival rate is as high as 80 percent in patients with hepatitis C and cirrhosis who have Child class A liver function and no variceal bleeding.³² However, once patients with any type of liver disease fall into the Child-Turcotte class B or class C category, survival is significantly reduced and transplantation should be considered.

How to decipher a biochemical blood test: the norm of indicators

Likbez

Health

November 11, 2020

This is a quick way to check your liver, kidneys, blood sugar and metabolic quality.

Why do we need a biochemical blood test

The meaning of a biochemical blood test (BAC) can be explained in a nutshell. If a general blood test (CBC) gives an idea of the state of the body as a whole, then the BAC adds details – it tells whether specific organs and systems are healthy.

A biochemical blood test helps to detect liver, kidney, diabetes and other ailments.

In addition, the LHC allows you to find out if everything is in order with the level of sugar in the blood, metabolism and what important vitamins, micro and macro elements, hormones, enzymes the body lacks for normal operation.

What the biochemical blood test shows

The laboratory assistant will take a few milliliters of blood from your vein. This must be done on an empty stomach – 8-12 hours after the last meal. The sample taken is then examined for several key components. They are divided into groups.

Glucose

Or blood sugar. Glucose is a source of energy for body cells. The body regulates its amount in the blood with various hormones (such as insulin) and enzymes. If there is too much or too little sugar, then something is wrong with the endocrine or excretory system.

Proteins

Albumin . It is a protein that is produced by the liver. Blood plasma is approximately 60% albumin.
Total protein . There are several dozen different proteins in the blood. Total protein is the average total of them.
Specific proteins . These are separate types of blood proteins, a change in the level of which may be associated with serious diseases. Specific ones include, in particular, C‑reactive protein (it signals an acute inflammatory process in the body), ferritin (needed for normal absorption of iron), myoglobin (creates the necessary supply of oxygen in muscles, including the heart), rheumatoid factor (antibodies that are produced only in case of serious diseases: infectious, muscular and connective tissues, autoimmune, oncological and others). Analysis for specific proteins is not always included in the standard LHC. If the doctor wants to find out the content of a particular substance in the blood, he will write about it in the direction for the study.

Lipids

The so-called lipid panel allows you to check the level of various types of cholesterol.

High density lipoproteins (HDL) . This is the so-called good cholesterol, which removes harmful substances from the blood and helps the liver break them down.
Low density lipoproteins (LDL) . We are talking about “bad” cholesterol, which causes the formation of plaques in the vessels and increases the risk of cardiovascular disease.
Total cholesterol . The sum of the values of “good” and “bad”.

Liver tests

This is the name given to the assessment of the level of certain enzymes associated with the state of the liver.

Total bilirubin . It is an orange-yellow pigment that is formed when hemoglobin is broken down. Bilirubin is toxic, so normally the liver quickly removes it from the body. But if hemoglobin is destroyed too actively or the liver cannot cope with normal volumes of bilirubin, the level of pigment in the blood rises sharply. This is often manifested externally – yellowing of the skin and whites of the eyes (jaundice).
Alanine aminotransferase (AlAt, ALT) . Liver enzyme necessary for amino acid metabolism. Its level rises with liver damage.
Aspartate aminotransferase (AsAt, AST) . Another enzyme that is released into the blood during serious disorders in the liver.
Alkaline Phosphatase . This is an enzyme involved in phosphorus metabolism. Its increase is also a marker of liver problems.

Kidney tests

Creatinine . This is a waste product that is formed in the muscles. It is excreted from the blood by the kidneys, so the level of creatinine is a good indicator of the work of this paired organ.
Uric acid . Formed in the liver and again excreted from the blood by the kidneys. If they fail (or, on the contrary, are unhealthy active), the level of uric acid in the blood rises (or falls).
Urea . It is also formed in the liver, where proteins are broken down, and excreted from the blood by the kidneys.

Inorganic substances (minerals, electrolytes) and vitamins

Calcium . One of the most important minerals in the body. Without it, the normal functioning of muscles, nerves, and heart is impossible. In addition, it is critical for bone development and repair.
Sodium . Responsible for the transmission of nerve impulses and helps to absorb calcium.
Magnesium . Like sodium, it is actively involved in the transmission of nerve impulses.
Chlorine . Helps to regulate the amount of fluid in the body and maintain acid-base balance.
Potassium . Critical to the normal functioning of the heart.
Iron . Necessary for the delivery of oxygen to organs and tissues.
Phosphorus . The nervous, muscular and skeletal systems are in great need of it.
Folic acid . Participates in a huge number of processes in the body – from the absorption of amino acids and glucose to the production of blood.
Vitamin B12 . It is essential for the production of red blood cells – erythrocytes.

What are the norms of blood parameters in LHC

The form with the results of a biochemical blood test, as a rule, is a table of three columns. The first contains the name of the indicator, the second contains the range of its normal values, and the third contains your result.

To check the norm, first of all, be guided by the numbers indicated on the form issued to you. The fact is that laboratories conduct tests on different reagents and under different conditions. Therefore, the optimal value ranges may vary slightly depending on the organization that processed your analysis. Only one thing is important for you: to check whether the result falls within the limits of the norms established by a particular laboratory.

The figures below are indicative for the most common indicators.

901 47

Indicator	Norm for an adult
Glucose	3, 9-5.6 mmol/l
Albumin	34-54 g/l
Total protein	60–83 g/l
HDL cholesterol	40 mg/dl and above for men; 50 mg/dl and above for women
LDL cholesterol	Less than 100 mg/dL
Total cholesterol	125–200 mg/dL
Total bilirubin	1.71–20.5 µmol/l
Alat , ALT	4–36 U/L
AsAt, AST	8–33 U/L
Alkaline Phosphatase	20-140 U/L
Creatinine	74 –107 µmol/L
Uric acid	3. 5-7.2 mg/dl
Urea	2.5-7.1 mmol/l
Calcium 90 151	2.2-2.7 mmol/l

How to decode a biochemical blood test

This can and should be done only by the doctor who issued you the referral for the analysis. For the reason that many different factors affect blood biochemistry.

Thus, an elevated blood glucose level can be both a symptom of prediabetes or diabetes, and a sign that you were irresponsible about the analysis and, let’s say, drank sweet coffee before it.

There are other examples. Elevated liver function tests are a marker of hepatitis and sometimes cirrhosis. But at the same time, ALT and AST can rise if you are being treated for a bacterial infection by taking antibiotics and other medications. A low urea level is a sign of serious liver damage. Or banal malnutrition if you are on a strict diet.

In general, let’s repeat it again. Only the doctor observing you should decipher the LHC. It is unacceptable to analyze the results of the tests on your own, and even more so to start self-treatment based on them.

Interpretation of liver tests and their disorders

04.10.2018

PDF article

It is not uncommon for a clinician to examine the liver to assess its functional state. The most commonly used indicators for this are alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and bilirubin. The measurement of these indicators is traditionally called “liver tests”. Some recommendations of the American College of Gastroenterology (2016) regarding the appointment and interpretation of liver tests are presented in the table.

Hepatocyte damage is usually characterized by a disproportionate increase in AST and ALT against a background of normal or slightly altered ALP; cholestasis, on the contrary, a sharp increase in alkaline phosphatase compared with ALT and AST. As for bilirubin, most of it circulates in the blood in an unconjugated form, and increased conjugated bilirubin may indicate both hepatocyte damage and cholestasis.

Diagnostic search for detected laboratory lesions of hepatocytes should include tests for viral hepatitis A, B and C, detection of NAFLD and ALD, screening for hereditary hemochromatosis, autoimmune hepatitis (AIH), Wilson’s disease, α-1-antitrypsin deficiency. The medical history should also be taken into account. With an increase in alkaline phosphatase, it is necessary to diagnose PBC and primary sclerosing cholangitis.

It is important that normal laboratory values are usually defined as the average value in a healthy population ± 2 standard deviations. This definition of the norm covers 95% of people, i.e., in 2.5% of the world’s population, these indicators, by definition, will exceed the norm. The normal levels of ALP and bilirubin differ less in different laboratories, while there is significant variability for ALT.

For example, in one study, 67 laboratories analyzed used an upper limit of normal (ULN) ALT of 31 to 72 U/L. It depends on the equipment of the laboratory, different methods for determining the quantitative indicator of the norm, the characteristics of the population used as healthy.

ALT is a more specific marker of liver damage than AST, but a normal ALT level does not rule out significant liver disease. An increase in AST without a concomitant increase in ALT may indicate damage to the heart or muscles. A borderline increase in AST and/or ALT is considered to be <2×ULN, slight - 2-5×ULN, moderate -5-15 ULN, severe - >15×ULN, and massive – >10,000 IU/L. The diagnostic algorithm at various levels of increase is shown in Figures 1-5.
AP is a member of the zinc metalloproteinase family that catalyzes the hydrolysis of phosphate esters at alkaline pH.

Interestingly, in people with blood type 1 or 2, serum ALP may increase after eating fatty foods, although this metabolic feature is rarely used in practice. The main reasons for the increase in the level of alkaline phosphatase are obstruction of the biliary tract (most often; possibly even in the absence of elevated bilirubin), pregnancy; Also, the level of alkaline phosphatase is increased in children and the elderly, especially in women. With a parallel increase in GGT, it can be concluded that the hepatic cause of the increase in alkaline phosphatase.

Bilirubin, bound to albumin, is formed from the breakdown of old red blood cells and predominantly circulates in unconjugated form. Unconjugated (indirect) bilirubin is not excreted in the urine. In turn, conjugated bilirubin becomes water-soluble and excreted into bile, then converted by intestinal bacteria into urobilinogen, excreted in urine and feces. It is the absence of urobilinogen that gives the feces a discolored appearance in violation of the outflow of bile. Unconjugated bilirubin makes up about 70% of total serum bilirubin.

Determination of bilirubin fractions is especially important when ALT, AST and ALP are in the normal range or slightly changed. If total bilirubin is elevated, mainly due to unconjugated bilirubin, hepatocellular damage is unlikely. An increase in direct bilirubin indicates such lesions or cholestasis.

Liver tests (ALT, AST, ALP, bilirubin) are markers of liver damage, not liver function. Albumin and PTT are indicators of hepatocyte function. Decreased albumin levels (normally ≥3.5 g/dL) usually indicate liver disease lasting ≥3 weeks, although any significant disease can decrease albumin levels due to cytokine exposure. PTT is a more sensitive measure of liver function as it may be elevated in patients with severe liver disease lasting <24 hours.

Of note, albumin, bilirubin, and PTT may be affected by extrahepatic factors. For example, in the presence of vitamin K deficiency and steatorrhea (in the absence of liver disease), cholestasis, or significant hepatocellular dysfunction, PTP lengthens. Treatment with warfarin, heparin bolus administration, disseminated intravascular coagulation syndrome, and hypothermia can also lead to an increase in PTT.

Certain liver diseases

Viral hepatitis B and C

The screening test for chronic hepatitis C is an antibody to the virus with a sensitivity of 92-97%. False positive results are observed in 5% of all cases and in 30% of patients without risk factors. Confirmation of chronic infection is provided by highly sensitive polymerase chain reaction (PCR) with the determination of viral RNA. Individuals with identified RNA should be referred to a specialist for further evaluation of infection and liver fibrosis, and a decision on antiviral therapy.

Acute hepatitis C, accompanied by higher levels of transaminases than chronic, usually occurs without jaundice and other clinical symptoms. The diagnosis of acute hepatitis C can be suspected in the presence of risk factors and confirmed using antibodies to the virus (positive 6-8 weeks after infection) and then by determining the virus RNA by PCR.

Hepatitis B testing should be done in all patients with persistently elevated AST/ALT. Determining the status of infection can be done using three serological tests: HBsAg, indicating the presence of infection; total antibodies to HBcAg, reporting previous exposure to infection or the presence of chronic HBV infection; antibodies to HBsAg, signaling the presence of immunity to this hepatitis that arose as a result of vaccination or a disease transferred in the past.

Chronic infection is confirmed by the presence of HBsAg, antibodies to the core antigen of the virus and / or the determination of viremia using a highly sensitive analysis for the detection of viral DNA. Individuals with chronic hepatitis B should be referred to a hepatologist for further evaluation and a decision on antiviral therapy. The diagnosis of acute hepatitis B is made with a positive test for IgM to HBcAg and the presence of HBsAg. Acute hepatitis B is more often than acute hepatitis C accompanied by clinical symptoms.

NAFLD

NAFLD is a very common metabolic syndrome-associated disease. Unlike ALD, there is no unique pattern of changes in ALT and AST for NAFLD, although ALT levels are usually more elevated than AST levels, and levels of both aminotransferases rarely exceed 300 IU/L. Although many individuals with NAFLD suspected of having steatosis on imaging studies may have normal liver tests, the presence of abnormal liver tests indicates a greater likelihood of non-alcoholic steatohepatitis. An accurate diagnosis of this diagnosis requires a liver biopsy, although the role of a non-invasive method for determining the degree of fibrosis and steatosis, elastography, is also increasing.

ABP

Alcohol use is a common cause of elevated liver tests, either alone or in association with chronic liver disease. Specific patterns of changes in liver tests are associated with ALD, in particular the AST:ALT ratio of at least 2:1, and transaminase values rarely exceed 300 IU / L. A further increase in this ratio (3:1, 4:1, etc.) increases the likelihood of ABP. An additional test is the measurement of GGT. All patients with elevated liver tests should be directly asked about alcohol use, recommending that it should be completely discontinued.

Autoimmune liver diseases

Chronic AIH, in which persistently elevated transaminases are noted, can develop in parallel with other autoimmune disorders (hypothyroidism, ulcerative colitis, Sjögren’s syndrome, rheumatoid arthritis, psoriasis). AIH is more common in women than in men (4:1). The characteristic laboratory signs of AIH are the presence of antinuclear antibodies, antismooth muscle antibodies, and less commonly, antirenal and antihepatic microsomal antibodies. The diagnosis of AIH requires histological confirmation with analysis taken from a liver biopsy of a tissue sample.

Drug injuries of the liver

Almost all drugs are associated with at least a minimal risk of elevated liver tests with or without concomitant hepatotoxicity. Among such drugs are antibiotics, antiepileptics, non-steroidal anti-inflammatory drugs, statins, anti-tuberculosis, chemotherapeutic and antiretroviral drugs. It should be noted that although statins are associated with increases in ALT and AST, cases of hepatotoxicity of these agents are rare, even in patients with chronic liver disease. Natural supplements associated with hepatotoxicity include ephedra preparations, green tea extract, and shark cartilage. An online source for information on drug hepatotoxicity is the livertox.nih.gov website. To determine drug damage, treatment should be stopped empirically until ALT/AST normalizes.

PBH

PBC, formerly known as primary biliary cirrhosis, is a rare chronic liver disease that predominantly affects the intralobular bile ducts at a microscopic level. PBC is more common in women than men and is associated with increased fatigue and itching. Laboratory examination reveals elevated alkaline phosphatase with or without elevated bilirubin, as well as the main criterion for diagnosis – a positive analysis for antimitochondrial antibodies (in > 95% of patients).

Other

In patients with jaundice and abdominal pain, a history of previous hepatobiliary disease, including cholelithiasis and inflammatory bowel disease, should be taken. Other extrahepatic causes of abnormal liver function tests include heart failure (congestive hepatopathy), early stages of emphysema, celiac disease, and thyroid disease.

Physical examination findings in patients with abnormal liver tests are usually normal, but some symptoms (jaundice, ascites, splenomegaly, palmar erythema, hepatic encephalopathy) may help confirm the presence of liver disease. In addition, the etiology of the disease can be suspected by specific symptoms. For example, contractures

Dupuytren in combination with an increase in the parotid salivary glands and testicular atrophy may accompany ALD; bronze skin color – hereditary hemochromatosis; severe hepatomegaly – acute viral or alcoholic hepatitis; enlarged nodular liver – a malignant process; right hypochondrium tenderness and a positive Murphy’s sign are hepatobiliary diseases (primarily cholecystitis).

From:
Paul Y. Kwo, Stanley M. Cohen, Joseph K. Lim. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol advance online publication, 20 December 2016; doi:10.1038/ajg.2016.517

Prepared by Larisa Strilchuk

Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018

Number:
Medical newspaper “Health of Ukraine 21 stories” No. 17 (438), spring 2018

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