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Overall view Of Liver Function Tests

About blood tests
Written by Jens Joergen Jaeger and Hanne Hedegaard, Denmark

What does it mean - and what is normal in Blood tests ? The names may be different in various countries –and so may the values. Please double-check with your own standards. Please find the tests in the boxes mentioned below.

These pages contains two different explanations to the bloodtests. The first one is a longer one and very thorough - with information about the normal ranges. (Please observe: there are different values in different countries). It might mainly be for healthcare persons . It is divided into various groups: Liver Function - Liver enzymes - Blood chemistry - Electrolytes - Lipids - Protein - Ratio's - Thyroid - Differential - and other. Please see the boxes.

There is also a shorter version = Common Laboratory Tests in Liver Diseases by Howard J. Worman, M. D. – This is meant to be read by patients and spouses.

Please observe: From the bloodtests: ALT (alanine aminotransferase) = SGPT (in Danish ALAT) - and AST (asparate aminotransferase) = SGOT (in Danish ASAT)

There is also a shorter version = Common Laboratory Tests in Liver Diseases by Howard J. Worman, M. D. – This is meant to be read by patients and spouses.

Please observe: From the bloodtests: ALT (alanine aminotransferase) = SGPT (in Danish ALAT) - and AST (asparate aminotransferase) = SGOT (in Danish ASAT)

Overall view

LIVER FUNCTION	AST / SGOT (short)	ALT / SGPT (short)	ALT or SGPT, long	AST or SGOT, long
	Albumin	Alkaline Phosphatase	Bilirubin, Total	Cholesterol
	GGT	Globulin	LDH	Protein, Total
Liver Enzymes	SGOT (Serum Glutamic-Oxalocetic Transaminase - AST)	SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)	ALKALINE PHOSPHA-TASE	GGT (Gamma-Glutamyl Transpeptidase)
	LDH (Lactic Acid Dehydrogenase)	BILIRUBIN, TOTAL	B.U.N. (Blood Urea Nitrogen)	CREATININE
	URIC ACID
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
Protein	PROTEIN, TOTAL	ALBUMIN	GLOBULIN	Albumin/Globulin Ratio
Electrolytes	SODIUM	POTASSIUM	CHLORIDE	CALCIUM
	CO2 (Carbon Dioxide)	PHOSPHORUS
Lipids	CHOLESTE-ROL	TRIGLY-CERIDES	LDL (Low Density Lipoprotein)	HDL (High Density Lipoprotein)
	CHOLESTE-ROL/LDL RATIO
Ratio's	ANION GAP (Sodium + Potassium - CO2 + Chloride)	BUN/CREATININE	CALCIUM/PHOSPHORUS	SODIUM/POTASSIUM
Thyroid	THYROXINE (T4) FREE T4 INDEX (T7)	T3-UPTAKE	THYROID-STIMULATING HORMONE (TSH)
Differential	NEUTRO-PHILS and NEUTROPHIL COUNT	LYMPHO-CYTES and COUNT	MONOCYTES and MONOCYTE COUNT	EOSINOPHILS and EOSINOPHIL COUNT
	BASOPHILS and BASOPHIL COUNT
Other	GLUCOSE (Fasting)	IRON, TOTAL

The long version:

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-

nduced 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

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)

Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21

SGPT (Serum Glutamic-Pyruvic Transaminase - ALT)

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)