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Normal range for ast and alt: High, Low & Normal Results, Symptoms & Causes

How to interpret ALT, AST, Bilirubin, Alkaline Phosphatase Tests

The American College of Gastroenterology (ACG) has released updated guidelines for blood chemistry tests used to assess liver health

New guidance is targeted at both professionals and primary care physicians.

This document provides specific values ​​for the normal range of alanine aminotransferase (ALT) levels, as well as stepwise screening algorithms for elevations in ALT, aspartic aminotransferase (AST), alkaline phosphatase, and bilirubin. In comparison with the documents of previous editions, the new recommendations contain reduced limits of the norm. Those. previous recommendations have considered upper limit values ​​(URL) as the norm, which can vary significantly between laboratories, ranging from 30-40 international units (IU) per liter in some institutions and up to 70-80 IU/l in others. According to the new guidelines, the normal range for ALT will be 19-25 IU/L for women and 29-33 IU/L for men.

Cirrhosis of the liver. Questions and answers

The authors noted that they are aware that due to the decrease in the limits of the norm, many patients will fall into the category with elevated rates and that this will create certain difficulties for doctors.

However, the authors consider the use of lower starting points justified, pointing out that sometimes even the smallest increase in ALT significantly increases the risk of death due to liver disease.

The authors point out that elevated ALT helps identify people with chronic liver diseases such as non-alcoholic fatty liver disease and chronic hepatitis C and B. over time, its level does not return to normal. The authors hope that, over time, practitioners will become accustomed to these new levels, and this will lead to improved liver health for all, as well as general health.

Key recommendations

  1. Before starting to assess liver function abnormalities, repeat the laboratory panel and/or perform a clarifying test (eg, GGT test if serum alkaline phosphatase is elevated) to confirm that the blood chemistry for liver actually are not normal. (Strong recommendation, very low level of evidence).
  2. Chronic hepatitis C testing is done with anti-HCV and confirmation is done with HCV RNA by nucleic acid testing. Risk factors for hepatitis C include a history of intranasal or intravenous drug use, tattoos, piercings, blood transfusions, and high-risk sexual behavior. Also at risk are people born between 1945 and 1965. Testing for acute hepatitis C is done with anti-HCV and HCV RNA by nucleic acid testing. (Strong recommendation, very low level of evidence).
  3. Testing for chronic hepatitis B is done with HBsAg testing. Testing for acute hepatitis B is associated with HBsAg and anti-HBc IgM.
    The following groups are most at risk: people born in endemic or hyperendemic areas (HBsAg prevalence > 2%), men who have sex with men, ever injecting drug users, dialysis patients, HIV-infected individuals, pregnant women and family members, family members and sexual contacts of HBV-infected persons. (Strong recommendation, very low level of evidence).
  4. Testing for acute hepatitis A (IgM HAV) should occur in patients with acute hepatitis and suspected fecal-oral exposure. Acute hepatitis E (IgM HEV) testing should also be done in those returning from endemic areas who test negative for acute hepatitis A, B, and C. (Strong recommendation, very low level of evidence).
  5. Patients with elevated BMI and other features of the metabolic syndrome, including diabetes mellitus, overweight or obesity, hyperlipidemia, or hypertension with mild ALT elevations, should undergo ultrasound screening for non-alcoholic fatty liver disease (NAFLD). (Strong recommendation, very low level of evidence).
  6. Women consuming more than 140 g of alcohol per week or men consuming more than 210 g per week who have AST>ALT should be considered at risk for alcoholic liver disease and should be advised to stop drinking alcohol. (Strong recommendation, very low level of evidence).
  7. All patients with abnormal liver function tests in the absence of acute hepatitis should be tested for hereditary hemochromatosis with iron, transferrin, and serum ferritin levels. HFE mutation analysis should be performed in patients with transferrin ≥45% and/or elevated serum ferritin. (Strong recommendation, very low level of evidence).
  8. Patients with abnormal AST and ALT levels, especially those with other autoimmune conditions, should be tested for autoimmune liver disease including ANA, ASMA, and globulin levels. (Strong recommendation, very low level of evidence).
  9. Patients with persistently elevated AST and ALT levels, especially those under 55 years of age, should be screened for Wilson’s disease with a serum ceruloplasmin test. If low ceruloplasmin is found, confirmatory testing with a 24-hour urine copper test and slit-lamp eye examination for abnormalities (Kaiser-Fleischer mosaic rings) is recommended. (Strong recommendation, very low level of evidence).
  10. Patients with persistently elevated AST or ALT should be screened for alpha-1 antitrypsin deficiency (A1AT) with the alpha-1 antitrypsin phenotype. (Strong recommendation, very low level of evidence).
  11. Doctors should ask patients with abnormal kidney tests about their medications and medications, including those they take on their own, without a doctor’s recommendation. It is also worth considering dietary or herbal supplements that may be associated with DILI. (Strong recommendation, very low level of evidence).
  12. Liver biopsy may be considered when serological testing and imaging fail to reveal a diagnosis, interpret the condition, or when multiple diagnoses are possible. (Strong recommendation, very low level of evidence).
  13. An increase in alkaline phosphatase should be confirmed by an increase in GGT. Given the lack of specificity for liver disease, GGT should not be used as a screening test for underlying liver disease in the absence of other abnormal liver findings. (Strong recommendation, very low level of evidence).
  14. Patients with elevated alkaline phosphatase with or without elevated bilirubin should be tested for PBC (previously called primary biliary cirrhosis) with antimitochondrial antibody testing. (Strong recommendation, very low level of evidence).
  15. Patients with alkaline phosphatase elevation with or without bilirubin elevation should be tested for PSC by MR cholangiography or ERCP with IgG4. (Strong recommendation, very low level of evidence).
  16. In patients with ALT and/or AST levels <5X ULN, laboratory investigations should evaluate the possibility of viral hepatitis B and C, alcoholic and NAFLD, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, autoimmune hepatitis and consider the possibility of drug poisoning and related with them liver damage. (Strong recommendation, very low level of evidence).
  17. In individuals with an ALT and/or AST level of 5-15X ULN, acute hepatitis A, B, and C should be considered in addition to all etiologies. (Strong recommendation, very low level of evidence).
  18. In individuals with ALT and/or AST > 15X ULN or massive ALT elevation > 10,000 IU/L, acetaminophen toxicity and ischemic hepatopathy (liver shock) should be considered. (Strong recommendation, very low level of evidence).
  19. A patient with acute hepatitis with elevated prothrombin time and/or encephalopathy requires immediate referral to a hepaologist. liver specialist. (Strong recommendation, very low level of evidence).

ALT, alanine aminotransferase; ANA, antinuclear antibodies; ASMA, anti-smooth antibody; AST, aspartate aminotransferase; BMI, body mass index; DILI, drug-induced liver injury; GGT, gamma-glutamyl transferase; HAV, hepatitis A virus; HBc, hepatitis B major antigen; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HEV, hepatitis E virus; HFE, hereditary hemochromatosis; IgM, immunoglobulin M; MR, magnetic resonance; NAFLD, non-alcoholic fatty liver disease; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis; ULN, upper limit of normal

Contributors to the guidelines:

Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine Palo Alto, California, USA; Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Yale Viral Hepatitis Program, Yale University School of Medicine. New Haven, Connecticut, USA. Correspondence: Paul Y. Kwo, MD, FACG, Division of Gastroenterology/Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, California 94304,USA

Source http://acgblog.org/

Tags diagnostics recommendation

Price list

Biochemistry is one of the most informative methods for diagnosing the state of the organism. It allows you to identify pathologies that cannot be determined visually, using palpation or other methods.

It is possible to take biomaterial around the clock and evaluate the parameters of blood biochemistry in a cat at the best price in the laboratory of the network of veterinary clinics “Svoi Doktor”. Our experts in the shortest possible time (from 12 hours to a day) will give a full detailed conclusion. This will help the veterinarian to quickly diagnose the disease and prescribe adequate treatment. With this analysis, you can also determine if the diet is suitable for your pet.

Scientists have long established the numerical values ​​of indicators of various chemical elements and compounds in the blood, corresponding to the vital activity of a healthy organism. The deviation of quantitative coefficients from the norm indicates the presence of certain problems. It is these discrepancies that allow the veterinarian to determine the presence and degree of pathology.

The functioning of all systems of the animal’s body implies a continuous chain of chemical reactions occurring as a result of the interaction of various enzymes. The most active enzymes are:

  • ALT (alanine aminotransferase) – takes part in amino acid metabolism. Normal level 10 – 80 (unit/liter):
    • increased levels – liver toxicity of any etiology, heart failure, shock, trauma,
    • decrease – cirrhosis or necrosis of the liver, lack of vitamin B6;
  • AST (aspartate aminotransferase) – causes the transfer of amino groups within cells. Norm 10 – 80 (unit / l):
    • exceeding the indicator – hepatitis, pancreatitis, physical overwork, heart failure,
    • low level – severe course of the disease (any), liver rupture;
  • CPK or CK (creatine phosphokinase) – is involved in the processes occurring in the heart, muscles, thyroid gland. The normal level is 150 to 798 units/litre;
  • ALP (alkaline phosphatase) – plays an important role in metabolic processes. Standard from 39up to 55 (u/l):
    • increase – bone disease, hyperparathyroidism, lymphogranulomatosis, liver problems, tumor of the biliary tract, pulmonary or kidney infarction, vitamin C overdose,
    • decrease – anemia, deficiency of zinc, magnesium, vitamin C, B12;
  • Alpha-amylase is a digestive enzyme produced by the pancreas. Normal level 580 – 1720 (u/l):
    • increase – pancreatitis or other pancreatic diseases, acute peritonitis, kidney problems.

What do deviations from the norm of some other biochemical parameters show:

  • urea – norm 6 – 12 (mmol / liter):
    • excess indicates heart failure, kidney disease, impaired urine outflow, oncology, shock, intestinal obstruction,
    • decrease below the minimum level – about a violation of the liver, poisoning with toxic substances;
  • creatinine – standard numbers 40 – 130 (µmol / l):
    • magnification indicates renal insufficiency, hyperthyroidism,
    • decrease – malnutrition and loss of muscle mass;
  • phosphorus – norm 1.1 – 2.3 (mmol / l):
    • excess indicates bone destruction, kidney disease, acidosis (blood acid-base imbalance), cirrhosis,
    • decrease – about rickets, periodontal disease, hypercalcemia, hyperparathyroidism, hyperinsulinemia;
  • calcium – normal range 2 – 2. 7 (mmol/l):
    • increase may indicate cancer, dehydration, kidney failure,
    • decrease – for rickets, osteodystrophy, pancreatitis, liver disease;
  • total protein (total concentration of albumin and globulin fractions) – the norm is 54 – 77 (g / l):
    • excess indicates an acute infectious disease, oncology, dehydration,
    • decrease below the standard range – about pancreatitis, diseases of the liver, intestines, kidneys, cancer, fasting.

For more information about your pet’s health problems, visit your veterinarian after a vein biochemistry test.

Biochemical analysis of blood in cats is performed strictly on an empty stomach. The accuracy of the results depends on many factors. Among them are the quality of the reagents used, the temperature regime, accounting for statistical errors, etc. The employees of our laboratory are certified specialists, and the research is carried out using modern equipment. Therefore, you can be sure of the high accuracy of our diagnostics.

Biomaterial is taken from a vein with sterile instruments. If the animal behaves calmly, then it is enough if the owner holds it during the procedure. If there is a chance that the cat will break out, then it is fixed on its side so that it does not injure the doctor. The puncture area is shaved from wool. As a rule, this is the front paw. For diagnosis, 1 ml of venous blood is sufficient. After manipulation, the paw is tightly bandaged. You can remove the bandage after 1 – 1.5 hours.

The sample is sent to the laboratory. After carrying out all the necessary studies, the formalized result will be provided to the attending physician.

Biomaterial sampling implies compliance with certain rules. Otherwise, the information about the analyzed indicators will be incorrect and may lead to the appointment of treatment that is ineffective in a particular case.

Preparation

What you need to do to donate blood biochemistry to a cat correctly:

  • do not feed the animal 8 hours before the clinic visit;
  • do not exercise excessively 2 days before the study;
  • tell your doctor if your pet is taking any medication. Perhaps the specialist will cancel the drug for several days or adjust its dosage.

How much does blood biochemistry cost for a cat depends on the number of parameters studied. The following research options are possible:

  • selective – in this case, certain elements are evaluated that are of interest to the doctor in a particular situation;
  • complex (profile) – a complex of elements is analyzed in order to identify the state of functioning of a certain system of the body. For example, this may be the diagnosis of renal, hepatic or cardiac parameters.

The price of laboratory diagnostics is increased by 50% if the result is required urgently (cito).

Cost of services
Name of services Standard deadlines* Price for 1 study Price Cito +50%
HEMATOLOGY AND HEMOPARASITES
CBC BASIC (A + automatic leukoformula) 12-24 hours 550 825
CBC STANDARD (A+L+ESR) 12-24 hours 900 1350
CBC ADVANCED (CBC+RTC+ESR) 12-24 hours 1000 1500
AUTOMATIC CELL COUNTING (A) without leukoformula 12-24 hours 500 750
ESR 12-24 hours 220 330
RETICULOCYTES (RTC) 12-24 hours 450 675
LEUKOFORMULA (L) 12-24 h 350 525
BABESIOSIS 1 (peripheral blood smear) 3-6 h 550 825
BABESIOSIS 2 (automatic + test tube blood smear for babesiosis) 3-6 h 750 1125
DIROFILARIOSIS COMPLEX (Knott + IC method) Up to 24 hours 2000 3000
DIROFILARIOSIS DIAGNOSIS (Knott method) Up to 24 hours 800 1200
Dirofilaria immitis (Express) 1 hour 1500 no
Cytoparasitic complex (A+mycoELISA+ChlamIFA) up to 5 days 2200 no
Blood typing in dogs and cats 3-6 h 2200 no
Blood compatibility 1 hour 550 825
PRIMARY EXAMINATION (8 indicators: total protein, glucose, AST, ALT, total bilirubin, urea, creatinine, alkaline phosphatase) 12-24 hours 1000 1500
OPTIMAL MINI (13 indicators: Total protein, Albumin, Globulin, Glucose, AST. , ALT, Total bilirubin, Direct bilirubin, Urea, Creatinine, Alkaline phosphatase, Cholesterol) 12-24 hours 1500 2250
OPTIMAL (18 indicators: Total protein, Albumin, Globulin, Glucose, AST., ALT, Total bilirubin, Direct bilirubin, Urea, Creatinine, Alkaline phosphatase, Cholesterol, P, Ca i, K, Na, Cl) 12-24 hours 1800 2700
MAXIMUM (25 indicators: Total protein, Albumin, Globulin, Glucose, LDH, Amylase, AST., ALT, Total bilirubin, Direct bilirubin, Urea, Creatinine, Alkaline phosphatase, GGT, Cholesterol, CPK, P, Ca , Ca i, K, Na, Fe, Mg, Cl, triglycerides) 12-24 hours 3000 4500
RENAL (13 indicators: Total protein, Albumin, Globulin, Glucose, Urea, Creatinine, P, Ca, Ca i, K, Na, Mg, Cl,) 12-24 hours 1250 1875
LIVER (13 indicators: Total protein, Albumin, Globulin, Glucose, AST. , ALT, Total bilirubin, Direct bilirubin, Urea, Alkaline phosphatase, GGT, Cholesterol, Triglycerides) 12-24 hours 1250 1875
SURGICAL (14 indicators: Total protein, Albumin, Globulin, Glucose, AST, ALT, Total bilirubin, Urea, Creatinine, Alkaline phosphatase, Ca i, K, Na, Cl) 12-24 hours 1500 2250
ELDERLY ANIMAL (13 indicators + T4: Total protein, Albumin, Globulin, Glucose, AST., ALT, Total bilirubin, Direct bilirubin, Urea, Creatinine, Alkaline phosphatase, Cholesterol) 12-24 hours 2500 3750
PREOPERATIVE COMPLEX (Surgical+A+Coagulogram) 12-24 2800 4200
CARDIAC (12 indicators: LDH, AST., ALT, Urea, Creatinine, CPK, Ca, Ca i, K, Na, Mg, Cl) 12-24 hours 1250 1875
EasyStat Blood gases and electrolytes ( Na+, K+, Cl-, PH, PCO2, HCO3-, tCO2, Anion gap. ) 1 hour 1650 2475
BIOCHEMISTRY
IONIC COMPOSITION (Na+K+Cl+iCa) 12-24 hours 450 675
Selected indicators: urine, creat, ob.bil, av.bil, AST, ALT, AP, GGT, LDH, glitch, ob.bel, alb, glob, cholest, Ca, P, Fe, Mg, triglycerides 12-24 hours 190 285
Selected indicators : Amylase, CPK, Lipase 12-24 hours 400 600
LIPASE, PANCREATIC (species-specific) 12-24 hours 2550 3825
Canine CRP Express until 12 noon 1600 no
Express Feline Serum Amyliod A (C-reactive protein) until 12 noon 1600 no
Express Cat/Canine Brain Natriuretic Propeptide (NT-proBNP) until 12 noon 2200 no
SDMA until 12 noon 2500 3750
Troponin until 12 noon 2200 3300
Fructosamine 12-24 hours 450 675
Ammonia 12-24 hours 700 1050
COAGULOGRAM
Coagulogram (APTT, prothrombin time, thrombin time, fibrinogen) 12-24 hours 1700 2550
DIAGNOSTIC COMPLEXES
DISPENSERIZATION OF DOGS (Optimal mini+Automatic+General urinalysis+I/g complex and protozoa+Dirofilariasis Knott method) 12-24 hours 3300 no
CAT DISPENSERIZATION (Optimal mini+Automatic+Complete urinalysis+I/g complex and protozoa) 12-24 hours 3000 no
ENDOCRINOLOGY: ELISA***
ELISA. T4 up to 5 days 1400 no
Express T4 until 12 noon 1700 no
T3 ELISA up to 5 days 1400 no
Canine TSH ELISA up to 5 days 1400 no
Express TSH until 12 noon 1700 no
triple T3+T4+TTG up to 5 days 3300 no
T4 free ELISA up to 5 days 1400 no
ELISA. Cortisol up to 5 days 1400 no
Express Cortisol until 12 noon 1700 no
Luteinizing hormone up to 5 days 1400 no
Estradiol up to 5 days 1400 no
ELISA. Progesterone 12-24 hours 1700 no
Progesterone Express until 12 noon 1700 no
Testosterone up to 5 days 1400 no
Small/Large Dexamethasone Sample up to 5 days 2500 no
Express D-Dimer until 12 noon 1900 no
DERMATOLOGY
Dermatophytes (wool microscopy) 12-24 hours 700 1050
Ectoparasite scraping (deep skin scraping) 12-24 hours 700 1050
Dermatological complex (wool microscopy + deep skin scraping) 12-24 hours 1100 1650
Otodectosis swab 12-24 hours 700 1050
Imprint smear with microscopy of stained slide 12-24 hours 700 1050
Wool microscopy + ringworm culture without antimycotic susceptibility 14-21 days 1550 no
Ringworm culture without antimycotic susceptibility 14-21 days 1000 no
CYTOLOG. RESEARCH. AFFECTED AREA (deep scraping) 3-5 days 1100 no
URINE
Urinalysis, incl. sediment microscopy 12-24 hours 800 1200
Urine protein to creatinine ratio 12-24 hours 400 600
COMPLEX (Complete urinalysis + White / Crea ratio) 12-24 hours 1000 1500
Nephrocomplex (URI TCA + Gram stain) 3-5 days 1500 no
Urinary cortisol to creatinine ratio 3-5 days 1100 1650
Gram stain 3-5 days 800 no
REPRODUCTION
Mating day determinations (Progesterone+Vaginal Pap Cytology) 12-24 hours 2200 3300
COPROLOGY
I/G+PROTOSE COMPLEX (native smear+Fülleborn flotation method) 12-24 hours 800 1200
GENERAL fecal analysis (including i/g and protozoa by native smear method) 12-24 hours 1100 1650
ELISA
MYCOPLASMOSIS IgG with TITER up to 5 days 1400 no
CHLAMYDIOSIS IgG with TITER up to 5 days 1400 no
TOXOPLASMOSIS IgG with TITER up to 5 days 1400 no
CORONAVIROSIS IgG with TITER up to 5 days 2200 no
LEUKEMIA ELISA with TITER up to 5 days 2200 no
ELISA ELISA with TITER up to 5 days 2200 no
Detection of IgG immunoglobulins for parvovirus, distemper and adenovirus (hepatitis) (with Titer) (DOGS) up to 5 days 2800 no
CALYCIVIROSIS, HERPES, PANLEUCOPENIA with Titer (CATS) up to 5 days 2800 no
IHA
Dogs
Parvovirus infection of carnivores (Ag) 12-24 hours 1100 no
Canine distemper (Ag) 12-24 hours 1100 no
Canine coronavirus (Ag) 12-24 hours 1100 no
Influenza (CIV h4 Ag) 12-24 1350 no
Adenovirus (CAV Ag) 12-24 hours 1350 no
Borreliosis (Ab) – Lyme 12-24 hours 1350 no
4-D: Anaplasmosis, Dirofilariasis, Borreliosis, Ehrlichiosis 12-24 hours 2200 no
Cats
Feline panleukopenia (Ag) 12-24 hours 1100 no
Feline coronavirus (Ag) 12-24 hours 1350 no
Feline Coronavirus (Ab) – Feline Viral Peritonitis 12-24 hours 1350 no
Feline leukemia virus (Ag) 12-24 hours 1100 no
Feline immunodeficiency virus (Ag) 12-24 hours 1100 no
General
Dirofilariasis (Ag) 12-24 hours 1500 no
Leishmaniasis (Ab) 12-24 hours 1500 no
Ehrlichiosis (Ab) 12-24 hours 1500 no
Giardiasis (Ag) 12-24 hours 1100 no
PATHOMORPHOLOGY
POINT STUDY, IMPRESSION, SCRAPING 3-5 days 1200 no
FLUID 3-5 days 1200 no
SYNOVIAL FLUID 3-5 days 1200 no
BLOOD CYTOLOGY 3-5 days 1200 no
TRANSUDATE AND EXSUDATE STUDY 3-5 days 1600 no
VAGINA CYTOLOGY (pathomorphology) 3-5 days 1200 no
PATHOMORPHOLOGY LABOCLEAN
Histological examination by a Russian pathologist (tumors – up to two locations, endoscopic/punch biopsies – up to 3 locations) – new 7 – 10 days 2800 no
Histological examination by a Russian pathologist (tumors – more than two locations, endoscopic/punch biopsies – more than 3 locations) – new 7 – 10 days 3900 no
Histological examination by a Russian pathologist (consultation on ready-made histological preparations) Issued only by our doctor at the appointment 3 – 5 days 2000 no
Cytology 1 – 3 days 1700 no
Cytology of effusion (including evaluation of cytosis) 1 – 3 days 1700 no
Cytological examination of skin scrapings/smears 1 – 3 days 1700 no
Vaginal cytology 1 – 3 days 1700 no
Synovial fluid cytology (no cytosis/protein assessment) 1 – 3 days 1700 no
Tracheal/bronchoalveolar lavage cytology 1 – 3 days 1700 no
Urine cytology (Gram stain) 1 – 3 days 1700 no
Bone marrow cytology 1 – 3 days 3500 no
Additional staining of preparations with supplemented pathologist’s conclusion (toluidine blue, CHIC, etc.

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