Blood

Range

Measure

WBC 4 - 11

Hb 13 - 16 G/oL

 Plts 150 - 450 L

Neutro 2.5 - 7.5 L

INR 0.9 - 1.2

ALT 5 - 55 Iu/L

AST 10 - 50 Iu/L

GGT 5 - 55 Iu/L

 Bili 3 - 20 Umol/L

Alb 35 - 50 Gil

Tprot 60 - 80 Gil

Glu 4 - 6 Mmol/L

Na 135 - 145 Mmol/L

K 3.5 - 5.0 Mmol/L

Urea 3.3 - 6.7 Mmol/L

Creat 45 - 120 Mmol/L

The routine blood tests that doctors usually do for liver problems are:
- Total Protein
- Albumin
- Globulin
- ALT or AST
- ALP
- GGT
- Bilirubin

Additional tests that may be done include:
- Gammaglobulins or Immunoglobulins (IgG, IgM and IgA).
- Autoantibodies
- Prothrombin Time (PT)
- Ferritin
- Copper
- Ceruloplasmin
- Virus screen (for hepatitis viruses A to E, and sometimes other viruses that occasionally cause hepatitis)

Note:
1. Different laboratories use different methods for measuring many of the above and "normal" values therefore vary between labs according to the method used. 2. Few of the above tests are completely specific for liver disease. What the doctor looks for is a pattern of abnormal results that gives a clue as to what is going on.

ALP (alkaline phosphatase): This is an enzyme produced partly by the liver. Increased levels in the blood may mean that there has been some damage to the bile ducts. However, ALP levels can be increased in a variety of other conditions or by several drugs (including some antibiotics).

Total protein: Because the liver produces most of the proteins that we have in our blood, this provides a crude measure of how well the liver is functioning.

Globulins: These are the second most abundant proteins in the blood. They include the gammaglobulins (which include the immunoglobulins, see below). Often, the total globulin is not measured separately - instead, its level is estimated simply by subtracting the albumin level from the Total Protein. Some globulins are made by the liver and others by white blood cells. The total globulin level is often increased when there is inflammation in the liver.

Gammaglobulins and Immunoglobulins: The gammaglobulins are a sub-group of the globulins (see above) comprised mainly of the immunoglobulins which, in turn, include antibodies and autoantibodies. There are three main types of immunoglobulins: IgG, IgM and IgA. These are normally present in the blood and are an essential component of our immune systems, mainly for providing defence against infections. Increased levels are usually associated with infections, but also occur in people with autoimmune diseases. In people suspected of having liver disease, doctors may test only for the total gammaglobulins but often they will request tests for the individual immunoglobulins because these can sometimes give a better clue about the type of liver disease. For example, the IgG is usually abnormally raised in autoimmune hepatitis (AIH) and the IgM in primary biliary cirrhosis (see the "PBC" section on this website).

Autoantibodies: These are antibodies that react against our own tissues (hence "auto"). Most of us have low levels of a very wide range of autoantibodies reacting with almost all of the different tissues in our bodies. These low levels are thought to play an important role in stopping our immune systems from damaging our own tissues. Abnormally high levels, however, usually indicate some type of autoimmune disease. The main ones that doctors usually test for in people suspected of having liver disease are: antinuclear (ANA), anti-smooth muscle (SMA), so-called type 1 anti-liver/kidney microsomal (anti-LKM1), and antimitochondrial (AMA) autoantibodies. Abnormal levels of ANA and SMA are usually found in AIH, but are also found in other autoimmune diseases and in some infections. Anti-LKM1 is most usually associated with a small sub-group of people with AIH and AMA is associated with PBC (see "PBC" and "Questions and Answers" sections). These autoantibodies are very useful for making the diagnosis but their actual levels do not tell the doctor much about how severe the liver disease is.

Prothrombin time (PT): Prothrombin is one of the so-called "clotting factors", which are a number of different proteins required to make our blood clot properly and most of which are produced by the liver. The PT is the test most widely used today but some doctors use other blood clotting tests, which are also useful. These clotting factors don't last very long in the blood after they are produced by the liver, so (in contrast to albumin, see above) they are a very sensitive measurement of how well the liver is functioning. An increased PT means that the damaged liver is not producing enough clotting factors. The PT is also the first test to return to normal when the liver begins to recover from damage.

Ferritin: This is a protein produced by the liver which normally carries iron around in the blood. When the liver is damaged, abnormal amounts are released from the liver cells and the blood levels rise to some extent. In this situation, blood levels are not very helpful to the doctor. However, very markedly increased blood levels are particularly associated with the iron-storage disease Haemochromatosis and are especially useful for diagnosis of this condition.

Copper and Ceruloplasmin: These two tests are used for the diagnosis of Wilson's disease, which is a rare condition in which there is abnormal storage of copper in the liver and other organs. Ceruloplasmin is a protein produced by the liver which carries copper around in the blood. In Wilson's disease, blood copper levels are often abnormally high and the ceruloplasmin level is usually low. In someone with a suspected liver problem, doctors will sometimes do these tests to make sure that they don't have Wilson's disease.

Virus screen: Doctors will usually request tests for virus infections to check whether or not this is the cause of a suspected liver problem. There is a whole range of hepatitis viruses (A, B, C, D, and E), as well as many other viruses that can occasionally cause hepatitis. Consequently, the number of different tests that can be performed is very large indeed. Usually, the doctor will first request what is known as a "screen" to check for the common (or most likely) ones. If the liver problem is found to be related to a virus infection, depending on which virus is involved, the doctor may then request additional tests for the particular virus to check on the nature and progress of the infection.

Plts (Platelets)
These are small fragments of cells known as megakaryocytes that are involved in the clotting process. If severe liver disease is present, blood flow through the spleen may become sluggish because of portal hypertension (increased pressure of blood in the portal vein, and slowed blood flow through the liver). This causes the spleen, which stores blood cells, to enlarge and to hold extrs platelets, causing the platelet count in the blood to fall.

INR

ALT or AST: ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are two enzymes that are produced by the liver as well as by other organs. They are normally present at low levels in the blood but the levels rise (sometimes quite markedly) when there is damage to the liver or other organs. They are generally a good marker of the severity of liver injury, although it is possible sometimes to have fairly severe liver damage with only slightly raised AST or ALT. Doctors often test for only one of these enzymes but may test for both.

GGT (gammaglutamyl transferase, or "gamma-GT")
GGT This is another enzyme produced partly by the liver. Blood levels are increased in a very wide variety of situations and by a large number of drugs, including herbal remedies and alcohol. However, if levels of both GGT and ALP are abnormal (known as a "cholestatic" pattern), this may raise suspicions of a problem with the liver and may indicate a disease affecting the bile ducts.

Bili (Bilirubin)
This is the pigment in bile. For further information, please see the "Questions and Answers" section on this website. It is normally present at low levels in the blood. High levels indicate either a problem with secretion of bile or excessive breakdown of red blood cells, and lead to yellowing of the skin and the whites of the eyes (jaundice).

Alb (Albumin)
This is the main protein in the blood and it is produced almost entirely by the liver. So, its measurement provides a more reliable (but still fairly crude) indication of how well the liver is working. However, albumin stays around in the blood for quite a long time after it is manufactured by the liver, so levels may not fall until some time after there has been quite severe (and usually fairly prolonged) liver damage.

Glu(Glucose)

Urea