LIVER FUNCTION TESTS

GEETHIKA GUMMADI
PHARM D

Liver function tests, also known as liver chemistries, help

determine the health of your liver by measuring the levels of proteins, liver
enzymes, and bilirubin in your blood.
Liver Function tests help to assess liver’s health and detect liver damage. These
blood tests measure the levels of certain proteins and enzymes in blood.
Proteins are large molecules that are needed for the overall health. Enzymes are
cellular proteins that help important chemical reactions to occur in the body.

A liver function test is often recommended in the following situations:

 to check for damage from liver infections, such as hepatitis

B and hepatitis C
 to monitor the side effects of certain medications known to affect the liver
 if already have a liver disease, to monitor the disease and how well a
particular treatment is working
 if experiencing the symptoms of a liver disorder
 if you have certain medical conditions such as high
triglycerides, diabetes, high blood pressure, or anemia
 if you drink alcohol heavily
 if you have gallbladder disease

Many tests can be performed on the liver. Certain tests can reflect different
aspects of liver function.

Commonly used tests to check liver abnormalities are tests checking:

 alanine transaminase (ALT)

 aspartate aminotransferase (AST)
 alkaline phosphatase (ALP)
 albumin
 bilirubin

The ALT and AST tests measure enzymes that liver releases in response to

damage or disease. The albumin test measures how well the liver creates
albumin, while the bilirubin test measures how well it disposes of bilirubin.
ALP can be used to evaluate the bile duct system of the liver.

Having abnormal results on any of these liver tests typically requires follow up
to determine the cause of the abnormalities. Even mildly elevated results can be
associated with liver disease. However, these enzymes can also be found in
other places besides the liver.

COMMON LIVER FUNCTION TESTS:

Liver function tests are used to measure specific enzymes and proteins in the
blood.

Depending on the test, either higher- or lower-than-normal levels of these

enzymes or proteins can indicate a problem with liver.

Some common liver function tests include:

LIVER ENZYME TESTS:

ALANINE TRANSAMINASE (ALT) TEST:

Alanine transaminase (ALT) is used by body to metabolize protein. If the liver

is damaged or not functioning properly, ALT can be released into the blood.
This causes ALT levels to increase.

A higher than normal result on this test can be a sign of liver damage.

According to the American College of Gastroenterology, an ALT above

25 IU/L (international units per liter) in females and

33 IU/L in males typically requires further testing and evaluation.

ASPARTATE AMINOTRANSFERASE (AST) TEST:

Aspartate aminotransferase (AST) is an enzyme found in several parts of body,

including the heart, liver, and muscles. Since AST levels aren’t as specific for
liver damage as ALT, it’s usually measured together with ALT to check for
liver problems.

When the liver is damaged, AST can be released into the bloodstream. A high
result on an AST test might indicate a problem with the liver or muscles.

The normal range for AST is typically up to 40 IU/L in adults and may be

higher in infants and young children.

ALKALINE PHOSPHATASE (ALP) TEST:

Alkaline phosphatase (ALP) is an enzyme found in bones, bile ducts, and liver.
An ALP test is typically ordered in combination with several other tests.

High levels of ALP may indicate liver inflammation, blockage of the bile ducts,
or a bone disease.

Children and adolescents may have elevated levels of ALP because their bones
are growing. Pregnancy can also raise ALP levels. The normal range for ALP is
typically up to 120 U/L in adults.

GAMMA GLUTAMYL TRANSPEPTIDASE:

Gamma-glutamyl transpeptidase (GGT) is an enzyme found in large amounts in

liver, bile ducts, and pancreas. The GGT test measures the level of GGT in

Blood. High levels of GGT can be a sign of liver or bile duct damage.
The normal range for GGT levels is 9–48 units per litre (U/L).

LIVER PROTEIN TESTS:

Albumin and globulin are two types of protein in your body. The total protein
test measures the total amount albumin and globulin in body. It is used as part
of routine health check-up. It may also be used if you have unexpected weight
loss, fatigue, or the symptoms of a kidney or liver disease.

ALBUMIN TEST

Albumin is the main protein made by liver. It performs many important bodily
functions. For example, albumin:

 stops fluid from leaking out of blood vessels

 nourishes tissues
 transports hormones, vitamins, and other substances throughout body

An albumin test measures how well liver is making this particular protein. A
low result on this test can indicate that liver is not functioning properly.

The normal range for albumin is 3.5–5.0 grams per deciliter (g/dL). However,
low albumin can also be a result of poor nutrition, kidney disease, infection, and
inflammation.

GLOBULIN TEST:

Globulins are a group of proteins in your blood. They are made in your liver by
your immune system. Globulins play an important role in liver function, blood
clotting, and fighting infection. There are four main types of globulins. They are
called alpha 1, alpha 2, beta, and gamma.
Normal value ranges are: Serum globulin: 2.0 to 3.5 grams per deciliter (g/dL)
or 20 to 35 grams per liter (g/L) IgM component: 75 to 300 milligrams per
deciliter (mg/dL) or 750 to 3,000 milligrams per liter (mg/L) IgG component:
650 to 1,850 mg/dL or 6.5 to 18.50 g/L.

A/G RATIO:

Normally, the A/G (albumin to globulin) ratio is slightly higher than 1. If the
ratio is too low or too high, additional testing must be done to determine the
cause and diagnosis. If the ratio is low, it can suggest:

 autoimmune disease
 multiple myeloma
 cirrhosis
 kidney disease

A high A/G ratio can indicate genetic deficiencies or leukemia

BILIRUBIN TEST

Bilirubin is a waste product from the breakdown of red blood cells. It’s
ordinarily processed by the liver. It passes through the liver before being
excreted through stool.

A damaged liver cannot properly process bilirubin. This leads to an abnormally

high level of bilirubin in the blood. A high result on the bilirubin test may
indicate that the liver is not functioning properly.

The normal range for total bilirubin is typically 0.1–1.2 milligrams per
deciliter (mg/dL). There are certain inherited diseases that raise bilirubin
levels, but the liver function is normal.

The normal level: Direct (also called conjugated) bilirubin: less than 0.3

mg/dL (less than 5.1 µmol/L)
Total bilirubin: 0.1 to 1.2 mg/dL (1.71 to 20.5 µmol/L)

L-LACTATE DEHYDROGENASE (LD):

LD is an enzyme found in the liver. Elevated levels may indicate liver damage
but can be elevated in many other disorders.

 Newborns -- 160-450 units per liter (U/L)

 Infants -- 100-250 U/L
 Children -- 60-170 U/L
 Adults -- 100-190 U/L

 70 U/L or lower for newborns

 40 U/L or lower for adults

PROTHROMBIN TIME (PT):

 PT is the time it takes blood to clot. Increased PT may indicate liver damage
but can also be elevated if you're taking certain blood-thinning drugs, such as
warfarin.

The normal range for PT results is: 11 to 13.5 seconds. INR of 0.8 to 1.1.

SPECIAL TESTS:
Bile acid levels
Blood ammonia
Alpha 1- antitrypsin
Alpha 1- fetoprotein
Hepatitis markers
Immunoglobulins
Cerloplasmin
Ferritin
LABORATORY INVESTIGATIONS FOR DIFFERENT CONDITIONS:
REFERENCE: https://www.healthline.com/health/liver-function-
tests#symptoms-of-a-liver-disorder
https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-
disease/diagnosing-liver-disease/#1503683241165-6d0a5a72-83a9