Liver Function Test (LFT)

 

Here is a breakdown of what an LFT (Liver Function Test) may include, what it does, normal values, and what other than normal values can mean. Also drugs and other things that can affect the results of each test.
The typical Liver Profile test includes:
Bilirubin
Protein
LDL
Alkaline Phosphatase
SGOT/AST (aspartate amino transferase)
SGPT/ALT (amino alanine transferase)
Albumin
Globulin

BLOOD BILIRUBIN:
Test evaluates liver function and the condition of red blood cells. Diagnoses jaundice. Monitors progression of jaundice. Helps confirm diagnosis of obstruction of the bile ducts. Helps diagnose cause of anemia.

Normal Values:
Adult indirect bilirubin levels--1.1 mg/dl or less
Adult direct bilirubin levels--Less than 0.5 mg/dl
Total bilirubin in a newborn--1 to 12mg/dl

What "high" or "increased" may indicate:
Congenital enzyme deficiencies (Gilbert's disease)
Liver damage
Severe hemolytic anemia
Obstruction of bile ducts from stones or tumors
If over 20mg/dl in a newborn, exchange transfusion may be needed.

Taking these drugs may affect test results:
Aminophenol, Anti-malarials, Ascorbic acid, Dextran, Epinephrine, Ethoxazene, Histidine, Indican, Isoproterenol, Levodopa, Methyldopa, Novobiocin, Phenazopyridine, Phenelzine, Primaquine, Rifampin, Streptomycin, Sulfa drugs, Theophylline, Tyrosine

BLOOD PROTEIN ELECTROPHORESIS (PROTEIN, ALBUMIN, GLOBULIN):
Purpose of the test is to help confirm blood disorders, gastrointestinal disorders, kidney disorders, liver disease, protein deficiency, diagnosis of tumors.

Normal values:
Protein--6.6 to 7.9g/dl
Albumin fraction--3.3 to 4.5g/dl
Alpha-1-globulin fraction--0.1 to 0.4g/dl
Alpha-2-globulin ranges--0.5 to 1g/dl
Beta globulin--0.7to 1.2g/dl
Gamma globulin--0.5 to 1.6g/dl


What "high" or "increased" may indicate:
Chronic inflammatory disease
Chronic syphilis
Collagen diseases
Dehydration
Diabetes mellitus
Diabetic acidosis
Early-stage Laennec's cirrhosis
Fulminating and chronic infections
Hodgkin's disease
Monocytic leukemia
Multiple myeloma
Rheumatoid arthritis
Subacute bacterial endocarditis
Systemic lupus erythematosus
Tuberculosis
Vomiting and diarrhea

What "low" or "decreased may indicate:
Acute cholecystitis
Benzene and carbon-tetracholoride poisoning
Blood dyscrasias
Collagen diseases
Congestive heart failure
Diarrhea
Diabetes mellitus, uncontrolled
Essential hypertension
Gastrointestinal disease
Hemorrhage
Hepatic disease
Hepatic dysfunction
Hodgkin's disease
Hyperthyroidism
Hypogammaglobulinemia
Malabsorption
Malnutrition
Metastatic carcinoma
Neoplastic and renal diseases
Nephritis
Nephrosis
Peptic ulcer
Plasma loss from burns
Rheumatoid arthritis
Sarcoidosis
Surgical or traumatic shock
Systemic lupus erythematosus
Toxemia of pregnancy

Taking these drugs may affect test results:
Cytotoxic agents, Cytotoxin, Cyclosporin

Other factors that may affect test results:
Pregnancy
Contrast dyes, such as sulfobromophthalein

BLOOD (SERUM) GLUTAMIC-OXALOACETIC TRANSAMINASE (SGOT)
Purpose of the test:
Helps diagnose recent severe heart problem
Helps detect and differentiate between varying forms of liver disease

Normal values:
Test values are more meaningful when correlated with test results for creatine phosphokinase and lactic dehydrogenase. Values fluctuate and may be transiently and minimally elevated during early phases of heart attack.

A rising level over several days means continuing damage
A decreasing level over several days means tissue repair
8 to 20u/liter
Normal values for infants are 4 times higher than those of adults

What "high" or "increased" may indicate:
Acute pancreatitis
Acute viral hepatitis
Alcoholic cirrhosis
Chronic hepatitis
Delirium tremens
Dermatomyositis
Drug-inducted liver injury
Duchenne muscular dystrophy
Extensive recent surgery
Fatty liver
Hemolytic anemia
Metastatic hepatic tumor
Pulmonary embolism
Severe infectious mononucleosis
Severe muscle trauma
Severe myocardial infarction
Severe passive liver congestion

Taking these drugs may affect test results:
Acetaminophen (large doses), Anti-tubercular agents, Chlorpropamide, Dicumarol, Erythromycin, Methyldopa, Opiates, Pyridoxine, Salicylates, Sulfonamides, Vitamin A

Other factors that may affect test results:
Strenuous exercise
Muscle trauma
Failure to fast overnight

BLOOD GLUTAMIC-PYRUVIC TRANSAMINASE (SGPT)

Purpose of the test:
Helps detect and evaluate treatment of acute hepatic disease
Helps distinguish between myocardial and hepatic-tissue damage

Normal values:
Men--10 to 32 u/liter
Women--9 to 24u/liter
Infants--Twice normal range of adults

What "high" or "increased" may indicate:
Severe hepatitis
Chronic hepatitis
Early or improving acute viral hepatitis
Infectious mononucleosis
Intrahepatic cholestasis
Cholecystitis
Severe hepatic congestion due to heart failure
Slight to moderately high levels may indicate any condition that produces acute hepatocellular injury.

Taking these drugs may affect test results:
Barbiturates, Chlorpromazine, Codeine, Griseofulvin, Isoniazid, Meperidine, Methyldopa, Morphine, Narcotic analgesics, Nitrofurantoin, Para-aminosalicylic acid, Phenothiazines, Phenytoin, Salicylates, Tetracycline

Other factors that may affect test results:
Eating lead
Exposure to carbon tetrachloride
Failure to fast overnight
If tourniquet is applied on the arm too long (over 1 minute), it may cause an inaccurate test result. Request another sample to be collected to ensure accuracy.

ALKALINE PHOSPHATASE:
Purpose of test:
Detects and identifies skeletal disease, especially diseases characterized by rapidly growing bone.
Detects liver diseases causing obstructions, such as a tumor or abscess.
Assesses response to vitamin D in treating rickets caused by vitamin-D deficiency.

Normal values:
(Alkaline phosphatase levels measured by chemical inhibition range from):
Men--90 to 239u/liter
Women (under age 45)--76 to 196u/liter
Women (over age 45)--87 to 250u/liter
Children normally have levels up to 3 times higher than adults

What "high" or "increased" may indicate:
Acute or complete biliary obstruction
Deficiency-induced rickets
Osteomalacia
Extensive bone metastases
Hyperparathyroidsm
Paget's disease

What "low" or "decreased" may indicate:
Hypophosphatasia
Protein deficiency
Magnesium deficiency

Taking these drugs may affect test results:
Albumin, Barbiturates, Chlorpropamide, Halothane, Isoniazid, Methyldopa, Oral contraceptives, Phenothiazines, Phenytoin, Rifampin

Other factors that may affect test results:
Healing long-bone fractures
Age (infants, children, adolescents, women over 45)
Failure to fast overnight
If tourniquet is applied on the arm too long (over 1 minute), it may cause an inaccurate test result. Request another sample be collected to ensure accuracy.

ANTI-NUCLEAR ANTIBODIES (ANA):
Purpose of test:
Screens for systemic lupus erythematosus
Screens for several autoimmune disorders
Monitors effectiveness of treatment with drugs for systemic lupus erythematosus

Normal values:
Test for Ana is negative at a titer of 1:32 or below

What absence of ANA may indicate:
Rules out systemic lupus erythematosus

What low titers may indicate:
Viral diseases
Liver disease
Collagen-vascular disease
Autoimmune disease

Taking these drugs may affect test results:
Acetazolamide, Aminosalicylic acid (PAS), Chlorothiazide, Chlorpromazine, Chlorprothixene, Clofibrate, Ethosuximide, Gold salts, Griseofulvin, Hydralazine, Isoniazid, Mephenytoin, Methyldopa, Methysergide, Oral contraceptives, Para-aminosaalicylic acid, Penicillin, Phenylbutazone, Phenytoin, Primidone, Procainamide, Propylthiouracil, Wuinidine, Reserpine, Streptomycin, Sulfonamides, Tetracyclines, Thiouracil, Trimethadion

Other factors that may affect test results:
If tourniquet is applied on the arm for too long (over 1 minute), it may cause an inaccurate test result. Request another sameple to be collected to ensure accuracy.

GAMMA GLUTAMYL TRANSFERASE (GGT):
Purpose of test:
Provides information about liver disease
Assesses liver function
Distinguishes between bone-and-joint disease and liver disease when blood alkaline-phosphatase levels are elevated.

Normal values:
Men--6 to 37u/liter
Women under 45--5 to 27u/liter
Women over 45--6 to 37u/liter

What "high" or "increased" may indicate:
Acute liver disease
Acute pancreatitis
Epilepsy
Brain tumor
Prostatic metastasis
Renal disease
Hepatic metastatic infiltrations
Obstructive jaundice
Possibly following myocardial infarction

Taking these drugs may affect test results:
Aminoglycosides, Barbiturates, Clofibrate, Oral contraceptives, Pehnytoin

Other factors that may affect test results:
Moderate intake of alcohol causes increased blood-GGT levels that may last for at least 60 hours.
Failure to fast overnight
If tourniquet is applied on the arm too long (over 1 minute), it may cause an inaccurate test result. Request another sample to be collected to ensure accuracy.

ISOCITRATE DEHYDROGENASE (ICD):
Purpose of the test:
Provides important information to assess presence and extent of liver damage
Detects early viral hepatitis and infectious mononucleosis
Distinguishes between liver disease and myocardial infarction when SGOT is elevated

Normal values:
Plasma-ammonia levels are less than 50mcg/dl

What "high" or "increased" may indicate:
Bleeding from the gastrointestinal tract
Congestive heart failure
Erythroblastosis fetalis
Reye's syndrome
Sever liver disease leading to hepatic coma

Taking these drugs may affect test results:
Acetazolamide, Ammonium salts, Furosemide, Danamycin, Lactulose, Neomycin, Thiazides

Other factors that may affect test results:
Portacaval shunt
Hyperalimentation
If tourniquet is applied on the arm too long (over 1 minute), it may cause an inaccurate test result. Request another sample to ensure accuracy.

PLASMA THROMBIN TIME (THROMBIN CLOTTING TIME):
Purpose of the test:
Detects fibrinogen deficiency or defect
Helps confirm diagnosis of DIC and liver disease
Monitors effectiveness of heparin, streptokinase, or urokinase treatment

Normal values:
Thrombin times range from 10 to 15 seconds. Test results are usually reported with a normal-control value.

What "high" or "increased" may indicate:
Dysfibrinogenemia
Effective heparin therapy
Liver disease
Hypofibrinogenemia
If DIC is suspected, an additional test for fibrin split products is also necessary

Taking these drugs may affect test results:
Anti-coagulants, Heparin

Other factors that may affect test results:
If tourniquet is applied on the arm too long (over 1 minute), it may cause an inaccurate test result. Request another sample to be collected to ensure accuracy.

AST, ALT, GGTP, AP

What do these letters mean?
These letters are acronyms for enzymes - proteins inside of cells. AST for example stands for aspartate amino transferase. This enzyme used to be called serum glutamic oxalacetic transaminase (SGOT), hence the two names. ALT = amino alanine transferase, GGTP= gamma glutamyl transpeptidase, and AP= alkaline phosphatase. Different cells have different enzymes inside them, depending on the function of the cell. Liver cells happen to have lots of AST, ALT, and GGTP inside them. When cells die or are sick the enzymes leak out causing the blood level of these enzymes to rise, which is a way of determining if the cells in question are sick. ALT is more specific for liver disease than AST because AST is made in more places (e.g. heart, intestine, muscle). So the AST will rise after a heart attack or bruised kidney. GGTP and AP are said to be more specific for biliary disease since they are made in bile duct cells. In liver disease caused by excess alcohol ingestion, the AST tends to exceed the ALT, while the reverse is true to for viral hepatitis. However, this particular generalization is often wrong.

Some points:
?These tests have meaning, but they generally cannot be interpreted without clinical information. They are probably most useful to track, or follow a particular problem, but even then they often "bounce around" greatly.
?These numbers are not linear. An AST that is 300 is not twice as bad as 150 (normal is less than 50). We are used to numbers like temperature and dollars. If it is 94 degrees F outside, it is warmer than if it is 80 every time. And if one has 94 dollars, one has more money than if one has 80. Liver enzyme values don't behave this way. An AST of 94 and 80 are essentially the same to a liver specialist.
?These numbers do not always detect all liver disease. Some very patients with severe advanced liver disease will have normal or nearly normal enzyme levels.

Are these numbers indicative of liver function?
Not really. Unfortunately, they are often called "liver function tests" or "LFT's", but in actuality, they do not measure function per se.

Then how is liver function measured?
Other tests including albumin, bilirubin, and prothrombin time are more truly measures of function, but clinical factors must be considered as well.

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