LIVER FUNCTION

A/G Ratio - Albumin - Alkaline Phosphatase - Bilirubin, Total - Cholesterol - GGT

Globulin - LDH - Protein, Total - AST/SGOT - ALT / SGPT

Liver Enzymes

ALT OR SGPT

ALT, an enzyme appears in liver cells, with lesser amounts in the kidneys, heart, and skeletal
muscles, and is a relatively specific indicator of acute liver cell damage. When such damage occurs,
ALT is released from the liver cells into the bloodstream, often before jaundice appears, resulting in
abnormally high serum levels that may not return to normal for days or weeks.

The purpose of this blood serum test is to help detect and evaluate treatment of acute hepatic
disease, especially hepatitis, and cirrhosis without jaundice. To help distinguish between
mytyocardial (heart) and liver tissue damage (used with the AST enzyme test). Also to assess
hepatotoxicity of some drugs.

ALT levels by a commonly used method range from 10 to 32 U/L; in women, from 9 to 24 U/L. (There
does exist differing ranges used by various laboratories.)

The normal range for infants is twice that of adults.

Very high ALT levels (up to 50 times normal) suggest viral or severe drug-

induced hepatitis, or other hepatic disease with extensive necrosis (death of liver cells). (AST levels
are also elevated but usually to a lesser degree.) Moderate-to-high levels may indicate infectious
mononucleosis, chronic hepatitis, intrahepatic cholestasis or cholecystitis, early or improving acute
viral hepatitis, or severe hepatic congestion due to heart failure. Slight-to-moderate elevations of
ALT (usually with higher increases in AST levels) may appear in any condition that produces acute
hepatocellular (liver cell) injury, such as active cirrhosis, and drug-induced or alcoholic hepatitis.

Marginal elevations occasionally occur in acute myocardial infarction (heart attack), reflecting
secondary hepatic congestion or the release of small amounts of ALT from heart tissue.

Many medications produce hepatic injury by competitively interfering with cellular metabolism.
Falsely elevated ALT levels can follow use of barbiturates, narcotics, methotrexate, chlorpromazine
salicylates (aspirin), and other drugs that affect the liver.

Be Aware: Serum liver enzymes can create confusion for both patients and physicians for these tests
are highly sensitive, but very non-specific. Tests commonly referred to as liver function tests or LFT's
do not actually determine liver function. Instead, they are static, primarily diagnostic parameters
that serve to detect liver disease rather than quantitative liver function. Rather than liver function
tests, it is more useful to refer to these tests as serum liver tests and to mentally categorise them
according to the pathophysiologic processes they truly reflect.

SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)

Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the liver but also to a
lesser degree, the heart and other tissues. It is useful in diagnosing liver function more so than SGOT
levels. Decreased SGPT in combination with increased cholesterol levels is seen in cases of a
congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney
infection, chemical pollutants or myocardial infarction.
Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24

AST or SGOT

One of the two main liver function blood serum tests (the other being the ALT test). The purpose of
this blood test is to detect a recent myocardial infarction (heart attack); to aid detection and
differential diagnosis of acute hepatic disease and to monitor patient progress and prognosis in
cardiac and hepatic diseases. AST levels by a commonly used method range from 8 to 20 U/L
although some ranges may express a maximum high in the 40s. (Check with your physician.)

AST levels fluctuate in response to the extent of cellular necrosis (cell death) and therefore may be
temporarily and minimally elevated early in the disease process, and extremely elevated during the
most acute phase. Depending on when the initial sample was drawn, AST levels can rise- indicating
increasing disease severity and tissue damage- or fall- indicating disease resolution and tissue repair.
Thus, the relative change in AST values serves as a reliable monitoring mechanism.

Maximum elevations are associated with certain diseases and conditions. For example, very high
elevations (more than 20 times normal) may indicate acute viral hepatitis, severe skeletal muscle
trauma, extensive surgery, drug- induced hepatic injury, and severe liver congestion. High levels
(ranging from 10 to 20 times normal) may indicate severe myocardial infarction (heart attack),
severe infectious mononucleosis, and alcoholic cirrhosis. High levels may also occur during the
resolving stages of conditions that cause maximal elevations. Moderate-to-high levels (ranging from
5 to 10 times normal) may indicate chronic hepatitis and other conditions. Low-to-moderate levels
(ranging from 2 to 5 times normal) may indicate metastatic hepatic tumours, acute pancreatitis,
pulmonary emboli, alcohol withdrawal syndrome, and fatty liver (steatosis).

SGOT (Serum Glutamic-Oxalocetic Transaminase - AST)

Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the liver, heart,
kidney, pancreas, and muscles. Seen in tissue damage, especially heart and liver, this enzyme is
normally elevated. Vitamin B deficiency and pregnancy are two instances where the enzyme may be
decreased.
Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21
Back to the English index

Blood Chemistry Definitions

Hematology - Hematocrit - Hemoglobin -

MCH (Mean Corpuscular Hemoglobin) -
MCV (Mean Corpuscular Volume) -
MCHC (Mean Corpuscular Hemoglobin Concentration)
R.B.C. (Red Blood Cell Count)
W.B.C. (White Blood Cell Count)
PLATELET COUNT
Hematology

HEMATOCRIT (HCT)

The word hematocrit means "to separate blood," a procedure which is followed following the blood
draw through the proper use of a centrifuge. Hematocrit is the measurement of the percentage of
red blood cells in whole blood. It is an important determinant of anemia (decreased) , polycythemia
(increased), dehydration (elevated), increased R.B.C. breakdown in the spleen (elevated), or possible
overhydration (elevated)
Normal Adult Female Range: 37 - 47%
Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

HEMOGLOBIN (HGB)

Hemoglobin is the main transport of oxygen and carbon dioxide in the blood. It is composed of
globin a group of amino acids that form a protein and heme which contains iron atoms and the red
pigment, porphyrin. As with Hematocrit, it is an important determinant of anemia (decreased),
dehydration (increased), polycythemia (increased), poor diet/nutrition, or possibly a malabsorption
problem.
Normal Adult Female Range: 12 - 16%
Optimal Adult Female Reading: 14
Normal Adult Male Range: 14 - 18%
Optimal Adult Male Reading: 16
Normal Newborn Range: 14 - 20%
Optimal Newborn Reading: 17

MCH (Mean Corpuscular Hemoglobin)

Hemoglobin x 10
R.B.C.
Mean Corpuscular Hemoglobin (MCH) gives the average weight of hemoglobin in the red blood cell.
Due to its use of red blood cells in its calculation, MCH is not as accurate as MCHC in its diagnosis of
severe anemia's. Decreased MCH is associated with microcytic anemia and increased MCH is
associated with macrocytic anemia.
Normal Adult Range: 27 - 33 pg
Optimal Adult Reading: 30

MCV (Mean Corpuscular Volume)

Hematocrit x 10
R.B.C.
The Mean Corpuscular Volume reflects the size of red blood cells by expressing the volume occupied
by a single red blood cell. Increased readings may indicate macrocytic anemia or B6 or Folic Acid
deficiency and decreased readings may indicate microcytic anemia, possibly caused by iron
deficiency.
Normal Adult Range: 80 - 100 fl
Optimal Adult Reading: 90
Higher ranges are found in newborns and infants

MCHC (Mean Corpuscular Hemoglobin Concentration)

Hemoglobin x 100
Hematocrit
This test measures the average concentration of hemoglobin in red blood cells. It is most valuable in
evaluating therapy for anemia because Hemoglobin and Hematocrit are used, not R.B.C. in the
calculation. Low MCHC means that a unit of packed R.B.C.’s contain less hemoglobin than normal
and a high MCHC means that there is more hemoglobin in a unit of R.B.C.’s. Increased MCHC is seen
in spherocytosis, and not seen in pernicious anemia whereas decreased levels may indicate iron
deficiency, blood loss, B6 deficiency of thalassemia.
Normal Adult Range: 32 - 36 %
Optimal Adult Reading: 34
Higher ranges are found in newborns and infants

R.B.C. (Red Blood Cell Count)

Red blood cells main function is to carry oxygen to the tissues and to transfer carbon dioxide to the
lungs. This process is possible through the R.B.C. containing hemoglobin which combines easily with
oxygen and carbon dioxide.
Normal Adult Female Range: 3.9 - 5.2 mill/mcl
Optimal Adult Female Reading: 4.55
Normal Adult Male Range: 4.2 - 5.6 mill/mcl
Optimal Adult Male Reading: 4.9
Lower ranges are found in Children, newborns and infants
Panel: Hematology

W.B.C. (White Blood Cell Count)

White blood cells main function is to fight infection, defend the body by phagocytosis against
invasion by foreign organisms, and to produce, or at least transport and distribute, antibodies in the
immune response. There are a number of types of leukocytes (see differential) that are classified as
follows
Granulocytes

Nongranulocytes

Band Neutrophiles

Lymphocytes

Neutrophils

Monocytes

Eosinophils

Basophils

Each cell, or leukocyte, has a different job in the body which is explained in the Differential section.
Normal Adult Range: 3.8 - 10.8 thous/mcl
Optimal Adult Reading: 7.3
Higher ranges are found in children, newborns and infants.

PLATELET COUNT

Platelets (also known as thrombocytes) are the smallest formed elements of the blood. They are
vital to coagulation of the blood to prevent excessive bleeding. Elevated levels suggest dehydration
or stimulation of the bone marrow where the cells are produced and decreased levels may indicate
an immune system failure, drug reactions, B12 or folic acid deficiency.
Normal Adult Range: 130 - 400 thous/mcl
Optimal Adult Reading: 265
Higher ranges are found in children, newborns and infants.

Electrolytes

SODIUM - POTASSIUM - CHLORIDE - CO2 (Carbon Dioxide) - CALCIUM - PHOSPHORUS -

SODIUM

Sodium is the most abundant cation in the blood and its chief base. It functions in the body to
maintain osmotic pressure, acid-base balance and to transmit nerve impulses.
Normal Adult Range: 135-146 mEq/L
Optimal Adult Reading: 140.5

POTASSIUM

Potassium is the major intracellular cation in the blood. It, along with sodium, helps to maintain
osmotic balance and in also involved in acid-base balance. It is needed for proper nerve and muscle
action.
Normal Range: 3.5 - 5.5 mEq/L
Optimal Adult Reading: 4.5

CHLORIDE

Chlorides significance relates to its maintenance of cellular integrity through it influence on osmotic
pressure, it also helps monitor acid-base balance and water balance. Elevated levels are related to
acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased
serum albumin may indicate water deficiency crossing the cell membrane (edema).

Normal Adult Range: 95-112 mEq/L

Optimal Adult Reading: 103
CO2 (Carbon Dioxide)

The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the
bodies buffering system. Generally when used with the other electrolytes, it is a good indicator of
acidosis and alkalinity.
Normal Adult Range: 22-32 mEq/L
Optimal Adult Reading: 27
Normal Childrens Range - 20 - 28 mEq/L
Optimal Childrens Reading: 24

CALCIUM

The most abundant mineral in the body, it is involved in bone metabolism, protein absorption, fat
transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. It
is highly sensitive to elements such as magnesium, iron and phosphorus as well as hormonal activity,
vitamin D levels, alkalinity and acidity, and many drugs.
Normal Adult Range: 8.5-10.3 mEq/dl
Optimal Adult Reading: 9.4

PHOSPHORUS

Phosphorus is an abundant element found in most tissues and cells. It is closely related to the
calcium level with an inverse relationship. When calcium is increased, phosphorus tends to decrease
and vice versa. Careful following of blood draw procedures are necessary because improper handling
may cause false elevated readings. Phosphorus is needed for its buffering action, calcium transport
and osmotic pressure.
Normal Adult Range: 2.5 - 4.5 mEq/dl
Optimal Adult Reading: 3.5
Normal Childrens Range: 3 - 6 mEq/dl
Optimal Childrens Range: 4.5
Liver Enzymes

SGOT (Serum Glutamic-Oxalocetic Transaminase - AST) -

SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)
ALKALINE PHOSPHATASE -
GGT (Gamma-Glutamyl Transpeptidase)
LDH (Lactic Acid Dehydrogenase)
BILIRUBIN, TOTAL
B.U.N. (Blood Urea Nitrogen)
CREATININE
URIC ACID

SGOT (Serum Glutamic-Oxalocetic Transaminase - AST)

Serum Glutamic Oxalocetic Transaminase or AST is an enzyme found primarily in the liver, heart,
kidney, pancreas, and muscles. Seen in tissue damage, especially heart and liver, this enzyme is
normally elevated. Vitamin B deficiency and pregnancy are two instances where the enzyme may be
decreased.
Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21

SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)

Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the liver but also to a
lesser degree, the heart and other tissues. It is useful in diagnosing liver function more so than SGOT
levels. Decreased SGPT in combination with increased cholesterol levels is seen in cases of a
congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney
infection, chemical pollutants or myocardial infarction.
Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24

ALKALINE PHOSPHATASE

Produced in the cells of the bone and liver with some activity in the kidney, intestine, and placenta,
it is mostly found in an alkaline state with a pH of 9. Used extensively as a tumor marker it is also
present in bone injury, pregnancy, or skeletal growth (elevated readings). Growing children have
normally higher levels of this enzyme also. Low levels are sometimes found in hypoadrenia, protein
deficiency, malnutrition and a number of vitamin deficiencies.
Normal Adult Range: 20 - 125 U/L
Optimal Adult Reading: 72.5
Normal Childrens Range: 40 - 400 U/L
Optimal Childrens Reading: 220

GGT (Gamma-Glutamyl Transpeptidase)

Believed to be involved in the transport of amino acids and peptides into cells as well as glutithione
metabolism, Gamma-Glutamyl Transpeptidase is mainly found in liver cells and as such is extremely
sensitive to alcohol use. Elevated levels may be found in liver disease, alcoholism, bile-duct
obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased
levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.
Normal Adult Female Range: 0 - 45 U/L
Optimal Female Reading: 22.5
Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5

LDH (Lactic Acid Dehydrogenase)

Lactic acid dehydrogenase is an intracellular enzyme from particularly in the kidney, heart, skelatal
muscle, brain, liver and lungs. Increases are usually found in cellular death and/or leakage from the
cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in
relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition,
hypoglycemia, adrenal exhaustion or low tissue or organ activity.
Normal Adult Range: 0 - 250 U/L
Optimal Adult Reading: 125

BILIRUBIN, TOTAL

A byproduct of the breakdown of red blood cells in the liver, bilirubin is a good indication of the
liver’s function. Excreted into the bile, bilirubin gives the bile its pigmentation. Elevated in liver
disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to
some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and
possibly a diet low in nitrogen bearing foods.
Normal Adult Range 0 - 1.3 mg/dl
Optimal Adult Reading: .65
Nitrogen Elements

B.U.N. (Blood Urea Nitrogen)

The nitrogen component of urea, B.U.N. is the end product of protein metabolism and its
concentration is influenced by the rate of excretion. Increases can be caused by excessive protein
intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure.
Decreased levels may be dur to a poor diet, malabsorption, liver damage or low nitrogen intake.
Normal Adult Range: 7 - 25 mg/dl
Optimal Adult Reading: 16

CREATININE

Creatinine is the waste product of muscle metabolism. Its level is a reflection of the bodies muscle
mass. Low levels are sometimes seen in kidney damage, protein starvation, liver disease or
pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting
creatinine, muscle degeneration, and some drugs involved in impairment of kidney function.
Normal Adult Range: .7 - 1.4 mg/dl
Optimal Adult Reading: 1.05

URIC ACID

Uric acid is the end product of purine metabolism and is normally excreted through the urine. High
levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia
in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage
or an overly acid kidney.
Normal Adult Female Range: 2.5 - 7.5 mg/dl
Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5
Protein

PROTEIN, TOTAL
ALBUMIN
GLOBULIN
A/G RATIO (Albumin/Globulin Ratio)

PROTEIN, TOTAL

Proteins are the most abundant compound in serum. The protein makeup of the individual is of
important diagnostic significance because of proteins involvement in enzymes, hormones and
antibodies as well as osmotic pressure balance, maintaining acid-base balance and as a reserve
source of nutrition for the bodies tissues and muscles. The major serum proteins measured are
Albumin and Globulin (alpha1, alpha2, beta and gamma). Decreased levels may be due to poor
nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus,
liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others. Careful
review of the individuals albumin, globulin and A/G ratio are recommended.
Normal Adult Range: 6.0 -8.5 g/dl
Optimal Adult Reading: 7.25

ALBUMIN

Albumin is the major constituent of serum protein (usually over 50%). It is manufactured by the liver
from the amino acids taken through the diet. It helps in osmotic pressure regulation, nutrient
transport and waste removal. High levels are seen rarely in liver disease, shock, dehydration, or
multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease,
inadequate iron intake, third-degree burns and edemas or hypocalcemia.
Normal Adult Range: 3.2 - 5.0 g/dl
Optimal Adult Reading: 4.1

GLOBULIN

Globulin, a larger protein than albumin, is important for its immunologic responses, especially its
gamma portion (IgA, IgG, IgM, and IgE). Globulins have many diverse functions such as, the carrier of
some hormones, lipids, metals, and antibodies. When chronic infections, liver disease, rheumatoid
arthritis, myelomas, and lupus are present, elevated levels are seen. You may find lower levels in
immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease.
Normal Adult Range: 2.2 - 4.2 g/dl (calculated)
Optimal Adult Reading: 3.2

A/G RATIO (Albumin/Globulin Ratio)

A/G ratio is an important indicator of disease states although a high level is not considered clinically
significant.
Normal Adult Range: 0.8 - 2.0 (calculated)
Optimal Adult Reading: 1.9

Lipids

CHOLESTEROL
TRIGLYCERIDES
LDL (Low Density Lipoprotein)
HDL (High Density Lipoprotein)
CHOLESTEROL/LDL RATIO

CHOLESTEROL

Cholesterol is a critical fat that is a structural component of cell membrane and plasma lipoproteins,
and is important in the synthesis of steroid hormones, glucocorticoids, and bile acids. Mostly
synthesized in the liver, some is absorbed through the diet, especially one high in saturated fats.
High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types
of cholesterol. Elevated cholesterol has been seen in artherosclerosis, diabetes, hypothyroidism and
pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia
and infection.
Normal Adult Range: 120 - 240 mg/dl
Optimal Adult Reading: 180

TRIGLYCERIDES

Triglycerides, stored in adipose tissues as glycerol, fatty acids and monoglyceroids, are reconverted
as triglycerides by the liver. Ninety percent of the dietary intake and 95% of the fat stored in tissues
are triglycerides. Increased levels may be present in artherosclerosis, hypothyroidism, liver disease,
pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome.
Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction,
hyperthyroidism, malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl
Optimal Adult Reading: 100

LDL (Low Density Lipoprotein)

LDL is the cholesterol rich remnants of the lipid transport vehicle VLDL (very-low density
lipoproteins) there have been many studies to correlate the association between high levels of LDL
and arterial artherosclerosis. Due to the expense of direct measurement of LDL a calculation, known
as the Friedewald formula is used. It is Total Cholesterol - HDL Cholesterol - Triglycerides/5. When
triglyceride levels are greater than 400, this method is not accurate.
Normal Adult Range: 62 - 130 mg/dl
Optimal Adult Reading: 81 mg/dl

HDL (High Density Lipoprotein)

HDL or High-density lipoprotein is the cholesterol carried by the alpha lipoproteins. A high level of
HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.
the two mechanisms that explain how HDL offers protection against chronic heart disease are that
HDL inhibits cellular uptake of LDL and serves as a carrier that removes cholesterol from the
peripheral tissues and transports it back to the liver for catabolism and excretion
Normal Adult Range: 35 - 135 mg/dl
Optimal Adult Reading: +85 mg/dl

CHOLESTEROL/LDL RATIO

The ratio of total cholesterol and LDL (low density lipoprotein).

Normal Adult Range: 1 - 6
Optimal Adult Reading: 3.5
Ratio's

ANION GAP (Sodium + Potassium - CO2 + Chloride)

BUN/CREATININE
CALCIUM/PHOSPHORUS
SODIUM/POTASSIUM

ANION GAP (Sodium + Potassium - CO2 + Chloride)

The anion gap is used to measure the concentration of cations (sodium and potassium) and the
anions (chloride and CO2) in the extracellular fluid of the blood. There are numerous clinical
implications that can be gathered from the Anion Gap. An increased measurement is associated with
metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased
levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is
in effect).
Normal Adult Range: 4 - 14 (calculated)
Optimal Adult Reading: 9

BUN/CREATININE

A high reading in this calculation is normally indicative of too much BUN being formed and a low
reading may show that the BUN is low or that the creatinine is not being cleared effectively by the
kidney. This calculation is a good measurement of kidney and liver function.
Normal Adult Range: 6 -25 (calculated)
Optimal Adult Reading: 15.5

CALCIUM/PHOSPHORUS

Due to the delicate balance between calcium and phosphorus in the system, this calculation is
helpful in noting subtle and acute imbalances in the relationship between the two elements.
Normal Adult Range: 2.3 - 3.3 (calculated)
Optimal Adult Reading: 2.8
Normal Children’s range: 1.3 - 3.3 (calculated)
Optimal Children’s Reading: 2.3

SODIUM/POTASSIUM

As the two major blood electrolytes, sodium as the extracellular cation and potassium as the
intracellular cation, this is an important ratio to review and act upon when subtle or acute
imbalances are noted.
Normal Adult Range: 26 - 38 (calculated)
Optimal Adult Reading: 32
Differential

NEUTROPHILS and NEUTROPHIL COUNT

LYMPHOCYTES and LYMPHOCYTE COUNT
MONOCYTES and MONOCYTE COUNT
EOSINOPHILS and EOSINOPHIL COUNT
BASOPHILS and BASOPHIL COUNT

NEUTROPHILS and NEUTROPHIL COUNT

Also known as Granulocytes or segmented neutrophils, this is the main defender of the body against
infection and antigens. High levels may indicate an active infection, a low count may indicate a
compromised immune system or depressed bone marrow (low neutrophil production.
Normal Adult Range: 48 - 73 %
Optimal Adult Reading: 60.5
Normal Children’s Range: 30 - 60 %
Optimal Children’s Reading: 45

LYMPHOCYTES and LYMPHOCYTE COUNT

Lymphocytes are involved in protection of the body from viral infections such as measles, rubella,
chickenpox, or infectious mononucleosis. Elevated levels may indicate an active viral infection and a
depressed level may indicate an exhausted immune system or if the neutrophils are elevated an
active infection.
Normal Adult Range: 18 - 48 %
Optimal Adult Reading: 33
Normal Children’s Range: 25 - 50 %
Optimal Children’s Reading: 37.5

MONOCYTES and MONOCYTE COUNT

These cells are helpful in fighting severe infections and are considered the bodies second line of
defense against infection and are the largest cells in the blood stream. Elevated levels are seen in
tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas. Low levels
are indicative of a state of health.
Normal Adult Range: 0 - 9 %
Optimal Adult Reading: 4.5

EOSINOPHILS and EOSINOPHIL COUNT

Eosinophils are used by the body to protect against allergic reactions and parasites. Therefore,
elevated levels may indicate an allergic response. A low count is normal.
Normal Adult Range: 0 - 5 %
Optimal Adult Reading: 2.5

BASOPHILS and BASOPHIL COUNT

Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin.
High levels are found in allergic reactions, low levels are normal.
Normal Adult Range: 0 - 2 %
Optimal Adult Reading: 1
Thyroid

THYROXINE (T4)
T3-UPTAKE
FREE T4 INDEX (T7)
THYROID-STIMULATING HORMONE (TSH)

THYROXINE (T4)

Thyroxine is the thyroid hormone that contains four atoms of iodine. It is used to evaluate thyroid
function. It is the direct measurement of total T4 concentration in the blood serum. Increased levels
are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism,
hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ug/dl
Optimal Adult Reading: 8 ug/dl

T3-UPTAKE

This test is an indirect measurement of unsaturated thyroxine binding globulin in the blood.
Increased levels are found in hyperthyroidism, severe liver disease, metastatic malignancy, and
pulmonary insufficiency. Decreased levels are found in hypothyroidism, normal pregnancy, and
hyperestrogenis status.
Normal Adult Range: 27 - 47%
Optimal Adult Reading: 37 %

FREE T4 INDEX (T7)

This index is a calculation used to correct the estimated total thyroxine for the amount of thyroxine
binding globulin present. It uses the T4 value and the T3 uptake ratio.
Normal Adult Range: 4 - 12
Optimal Adult Reading: 8

THYROID-STIMULATING HORMONE (TSH)

TSH, produced by the anterior pituitary gland, causes the release and distribution of stored thyroid
hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSH
secretion increases.
Normal Adult Range: .5 - 6 miliIU/L
Optimal Adult Reading: 3.25 miliU/L

Other

GLUCOSE (Fasting)
IRON, TOTAL

GLUCOSE (Fasting)

Glucose, formed by the digestion of carbohydrates and the conversion of glycogen by the liver is the
primary source of energy for most cells. It is regulated by insulin, glucagon, thyroid hormone, liver
enzymes and adrenal hormones. It is elevated in diabetes, liver disease, obesity, pancreatitis,
steroids, stress, or diet. Low levels may be indicative of liver disease, overproduction of insulin,
hypothyroidism, or alcoholism.
Normal Adult Range: 60 - 115 mg/dl
Optimal Adult Reading: 87.5
IRON, TOTAL

Iron is necessary for the formation of some proteins, hemoglobin, myoglobin, and cytochrome. Also
it is necessary for oxygen transport, cellular respiration and peroxide deactivation. Low levels are
seen in many anemias, copper deficiencies, low vitamin C intake, liver disease, chronic infections,
high calcium intake and women with heavy menstrual flows. High levels are seen in
hemochromitosis, liver damage, pernicious anemia and hemolytic anemia.
Normal Adult Range: 30 - 170 mcg/dl
Optimal Adult Reading: 100

Common Laboratory Tests in Liver Diseases

Howard J. Worman, M. D.

ALT - AST - Alkaline phosphatase - Gamma-glutamyltranspeptidase (GGT) - Bilirubin - Albumin -

Prothrombin time (PT) - Platelet count - Serum protein electrophoresis

The diagnosis of liver diseases depends upon a combination of history, physical examination,
laboratory testing and sometimes radiological studies and biopsy. Only a physician who knows all of
these aspects of a specific case can reliably make a diagnosis. Many individuals with liver diseases
nonetheless have questions about their laboratory test results and seek information about their
significance. The purpose of this page is to briefly describe some of the common laboratory tests
that may be abnormal in individuals with liver diseases. Patients reading this page must keep in mind
that abnormalities of these laboratory tests are not diagnostic of specific diseases and that only a
qualified physician who knows the entire case can provide a reliable diagnosis.

Alanine aminotransferase (ALT)

ALT is an enzyme produced in hepatocytes, the major cell type in the liver. ALT is often inaccurately
referred to as a liver function test, however, its level in the blood tells little about the function of the
liver. The level of ALT in the blood (actually enzyme activity is measured in the clinical laboratory) is
increased in conditions in which hepatocytes are damaged or die. As cells are damaged, ALT leaks
out into the bloodstream. All types of hepatitis (viral, alcoholic, drug-induced, etc.) cause hepatocyte
damage that can lead to elevations in the serum ALT activity. The ALT level is also increased in cases
of liver cell death resulting from other causes, such as shock or drug toxicity. The level of ALT may
correlate roughly with the degree of cell death or inflammation, however, this is not always the case.
An accurate estimate of inflammatory activity or the amount cell death can only be made by liver
biopsy. (See also aspartate aminotransferase below.)

Aspartate aminotransferase (AST)

AST is an enzyme similar to ALT (see above) but less specific for liver disease as it is also produced in
muscle and can be elevated in other conditions (for example, early in the course of a heart attack).
AST is also inaccurately referred to as a liver function test by many physicians. In many cases of liver
inflammation, the ALT and AST activities are elevated roughly in a 1:1 ratio. In some conditions, such
as alcoholic hepatitis or shock liver, the elevation in the serum AST level may higher than the
elevation in the serum ALT level.

Alkaline phosphatase

Alkaline phosphatase is an enzyme, or more precisely a family of related enzymes, produced in the
bile ducts, intestine, kidney, placenta and bone. An elevation in the level of serum alkaline
phosphatase (actually enzyme activity is measured in the clinical laboratory), especially in the setting
of normal or only modestly elevated ALT and AST activities, suggests disease of the bile ducts. Serum
alkaline phosphatase activity can be markedly elevated in bile duct obstruction or in bile duct
diseases such as primary biliary cirrhosis or primary sclerosing cholangitis. Alkaline phosphatase is
also produced in bone and blood activity can also be increased in some bone disorders.

Gamma-glutamyltranspeptidase (GGT)

An enzyme produced in the bile ducts that, like alkaline phosphatase, may be elevated in the serum
of patients with bile duct diseases. Elevations in serum GGT, especially along with elevations in
alkaline phosphatase, suggest bile duct disease. Measurement of GGT is an extremely sensitive test,
however, and it may be elevated in virtually any liver disease and even sometimes in normal
individuals. GGT is also induced by many drugs, including alcohol, and its serum activity may be
increased in heavy drinkers even in the absence of liver damage or inflammation.

Bilirubin

Bilirubin is the major breakdown product that results from the destruction of old red blood cells (as
well as some other sources). It is removed from the blood by the liver, chemically modified by a
process call conjugation, secreted into the bile, passed into the intestine and to some extent
reabsorbed from the intestine. Bilirubin concentrations are elevated in the blood either by increased
production, decreased uptake by the liver, decreased conjugation, decreased secretion from the
liver or blockage of the bile ducts. In cases of increased production, decreased liver uptake or
decreased conjugation, the unconjugated or so-called indirect bilirubin will be primarily elevated. In
cases of decreased secretion from the liver or bile duct obstruction, the conjugated or so-called
direct bilirubin will be primarily elevated. Many different liver diseases, as well as conditions other
than liver diseases (e. g. increased production by enhanced red blood cell destruction), can cause the
serum bilirubin concentration to be elevated. Most adult acquired liver diseases cause impairment in
bilirubin secretion from liver cells that cause the direct bilirubin to be elevated in the blood. In
chronic, acquired liver diseases, the serum bilirubin concentration is usually normal until a significant
amount of liver damage has occurred and cirrhosis is present. In acute liver disease, the bilirubin is
usually increased relative to the severity of the acute process. In bile duct obstruction, or diseases of
the bile ducts such as primary biliary cirrhosis or sclerosing cholangitis, the alkaline phosphatase and
GGT activities are often elevated along with the direct bilirubin concentration.

Albumin

Albumin is the major protein that circulates in the bloodstream. Albumin is synthesized by the liver
and secreted into the blood. Low serum albumin concentrations indicate poor liver function. The
serum albumin concentration is usually normal in chronic liver diseases until cirrhosis and significant
liver damage is present. Albumin levels can be low in conditions other than liver diseases including
malnutrition, some kidney diseases and other rarer conditions.

Prothrombin time (PT)

Many factors necessary for blood clotting are made in the liver. When liver function is severely
abnormal, their synthesis and secretion into the blood is decreased. The prothrombin time is a type
of blood clotting test performed in the laboratory and it is prolonged when the blood concentrations
of some of the clotting factors made by the liver are low. In chronic liver diseases, the prothrombin
time is usually not elevated until cirrhosis is present and the liver damage is fairly significant. In
acute liver diseases, the prothrombin time can be prolonged with severe liver damage and return to
normal as the patient recovers. Prothrombin time can also be prolonged in cases of vitamin K
deficiency, by drugs (warfarin, used therapeutically as an anti-coagulant, prolongs the prothrombin
time) and in non-liver disorders.

Platelet count

Platelets are the smallest of the blood cells (actually fragments of larger cells known as
megakaryocytes) that are involved in clotting. In some individuals with liver disease, the spleen
becomes enlarged as blood flow through the liver is impeded. This can lead to platelets being
sequestered in the enlarged spleen. In chronic liver diseases, the platelet count usually falls only
after cirrhosis has developed. The platelet count can be abnormal in many conditions other than
liver diseases.

Serum protein electrophoresis

In this test, the major proteins in the serum are separated in an electric field and their
concentrations determined. The four major types of serum proteins whose concentrations are
measured in this test are albumin, alpha-globulins, beta-globulins and gamma-globulins. Serum
protein electrophoresis is a useful test in patients with liver diseases as it can provide clues to
several diagnostic possibilities. In cirrhosis, the albumin may be decreased (see above) and the
gamma-globulin elevated. Gamma-globulin can be significantly elevated in some types of
autoimmune hepatitis. The alpha-globulins can be low in alpha-1-antitrypsin deficiency.
Normal Results
Normal value ranges are:

Total protein: 6.4 to 8.3 g/dL (grams per deciliter)

Albumin: 3.5 to 5.0 g/dL
Alpha-1 globulin: 0.1 to 0.3 g/dL
Alpha-2 globulin: 0.6 to 1.0 g/dL
Beta globulin: 0.7 to 1.2 g/dL
Gamma globulin: 0.7 to 1.6 g/dL
The examples above are common measurements for results of these tests. Normal value ranges may
vary slightly among different laboratories. Some labs use different measurements or test different
samples. Talk to your doctor about the meaning of your specific results.

What Abnormal Results Mean

Decreased total protein may indicate:

Abnormal loss of protein from the digestive tract or the inability of the digestive tract to absorb
proteins (protein-losing enteropathy)
Malnutrition
Kidney disorder called nephrotic syndrome
Scarring of the liver and poor liver function (cirrhosis)
Increased alpha-1 globulin proteins may be due to:

Acute inflammatory disease

Cancer
Chronic inflammatory disease (for example, rheumatoid arthritis, SLE)
Decreased alpha-1 globulin proteins may be a sign of:

Alpha-1 antitrypsin deficiency

Increased alpha-2 globulin proteins may indicate a:

Acute inflammation
Chronic inflammation
Decreased alpha-2 globulin proteins may indicate:

Breakdown of red blood cells (hemolysis)

Increased beta globulin proteins may indicate:
A disorder in which the body has problems breaking down fats (for example, hyperlipoproteinemia,
familial hypercholesterolemia)
Estrogen therapy
Decreased beta globulin proteins may indicate:

Abnormally low level of LDL cholesterol

Malnutrition
Increased gamma globulin proteins may indicate:

Bone marrow cancer called multiple myeloma

Chronic inflammatory disease (for example, rheumatoid arthritis)
Overactive immune system (hyperimmunization)
Acute infection
White blood cell cancer called Waldenstrom macroglobulinemia
Chronic liver disease
Risks
There is very little risk involved with having your blood taken. Veins and arteries vary in size from
one patient to another and from one side of the body to the other. Taking blood from some people
may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

Excessive bleeding
Fainting or feeling light-headed
Hematoma (blood accumulating under the skin)
Infection (a slight risk any time the skin is broken)