This Web Site is committed to the memory of Janis Morrow.
Labs
Written by Jens Joergen Jaeger and Hanne Hedegaard, Denmark
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)
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)
The long version:
LIVER FUNCTION
A/G Ratio
-
Albumin
-
Alkaline Phosphatase
-
Bilirubin, Total
-
Cholesterol
-
GGT
Globulin
-
LDH
-
Protein, Total
-
AST/SGOT
-
ALT / SGPT
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)
W.B.C.
(White Blood Cell 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)
GGT
(Gamma-Glutamyl Transpeptidase)
LDH
(Lactic Acid Dehydrogenase)
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
i
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
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
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)
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
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
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
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
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AST
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Alkaline phosphatase
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Gamma-glutamyltranspeptidase (GGT)
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Bilirubin
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Albumin
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Prothrombin time (PT)
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Platelet count
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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 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 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.
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.
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.
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.