Nebraska Health & Human Services Hepatitis Prevention Program July 2007 Common Liver Function Tests Name Alanine Aminotransferase Alias ALT or SGPT Male 7-46 U/ml Normal Values Female 5-35 U/ml Child 3-37 U/L Enzyme produced by the liver that acts as a catalyst in amino acid production. High concentrations are found in liver cells and moderate concentrations in body fluids, heart, kidney, and skeletal muscles. Nursing Notes: Numerous drugs including ETOH can falsely elevate levels. Uremia & Hemodialysis can falsely decrease levels. A hemolyzed specimen can cause falsely elevated levels. Name Aspartate Aminotransferase Alias AST or SGOT Male 8-26 U/L Normal Values Female 8-20 U/L Child 19-28 U/L Enzyme that catalyzes the reversible transfer of an amino between the amino acid. High concentrations are in the liver and heart cells, with lower concentrations found in skeletal muscles, kidney, pancreas, and the brain. Nursing Notes: Numerous drugs and Vitamin A can falsely elevate levels. A hemolyzed specimen can cause falsely elevated levels. Name Gamma-glutamyl Transpeptidase Alias GGT or GGTP Male 10-39 IU/L Normal Values Female 6-29 IU/L Child 0-23 IU/L Enzyme that participates in the transfer of amino acids and peptides across cellular membranes. High concentrations are found in the liver, bile ducts, and kidneys. Lower concentrations are found in the prostate gland, brain, and heart. Nursing Notes: Numerous drugs including ETOH can elevate levels. Oral contraceptives can lower levels. A hemolyzed specimen can cause falsely elevated results. Name Bilirubin Alias Indirect Bili Male 0.3-1.1 mg/dl (Adult) Normal Values Female Child Direct Bili 0.1-0.4 mg/dl (Adult) Bilirubin is a degradation product of the pigmented heme portion of hemoglobin. Old and abnormal red blood cells are removed from circulation by the spleen and to some extent by the liver. Nursing Notes: Certain drugs can elevate Bilirubin levels. A hemolyzed specimen can cause falsely elevated results. Prolonged exposure to U.V. or sunlight can lower Bilirubin levels. Name Alkaline Phosphatase Alias ALP or Alk Phos Male 98-251 U/L Enzyme found in the liver, the biliary tract, bone, intestines, and placenta. Nursing Notes: Many drugs can falsely elevate or decrease levels. A hemolyzed specimen can cause falsely elevated results. Normal Values Female 81-196 U/L Child Nebraska Health & Human Services Hepatitis Prevention Program July 2007 Other Liver Laboratory Blood Tests Name Alias Normal Values Adult Albumin Alb Child 3.0 - 5.0 g/dL 3.4 to 5.4 g/dL Primarily by the liver, patients with chronic liver disease accompanied by cirrhosis often have levels of Albumin < 3 g/dl. Nursing Notes: Large amounts of IV fluids can cause inaccurate test results. Albumin levels are decreased during pregnancy. Drugs that can increase albumin measurements include anabolic steroids, androgens, growth hormone & insulin Name Alias Normal Values Adult Ammonia Child 40-80 μg/dL 15-45 μg/dL NH₃ The liver converts Ammonia in the portal blood to urea for excretion by the kidneys. With impaired liver function, especially when combined with impaired portal blood flow, Ammonia levels rise. Nursing Notes: Specimen must be drawn on ice and processed immediately. Hemolysis will cause elevated levels. Excessive protein intake will cause elevated levels. Patients should be fasting for 8 hours prior to sample collection. Patients should not smoke for 8-10 hours prior to sample collection. Patients should avoid strenuous activity 8 hours prior to sample collection. Name Immunoglobulins Alias Serum Electrophoresis Normal Values IgA 140-400 mg/dL IgD 0-8 mg/dL IgG 700-1500 mg/dL IgM 35-375 mg/dL A variety of immunoglobulins are increased in patients with chronic liver disease. Elevations of IgA, IgD, IgG, and IgM can be suggestive of specific liver diseases; see specifics below nursing notes. Nursing Notes: Hemolysis of sample can interfere with results. Many drugs can falsely elevate or decrease levels. Vaccinations within the past 6 months can interfere with results. Receiving blood products within the past 6 months can interfere with results. Elevated IgA Elevated IgD Elevated IgG Elevated IgM Name Alcoholic Liver Disease, Cirrhosis, Hepatitis, Laennec's Cirrhosis, Hepatobiliary Carcinoma Chronic infections, Liver diseases Autoimmune Hepatitis, Hepatitis, Hepatitis C, Laennec's Cirrhosis Biliary Cirrhosis, Hepatitis, Viral infections Alias Normal Values Adult Platelets PLT or Thrombocyte Child 170,000-380,000/mm³ 150,000-450,000/mm³ The liver releases Thrombopoietin to stimulate platelet production. Increased Platelet levels can be seen with Cirrhosis and decreased Platelet levels can be seen with Viral Infections and Splenomegaly due to liver disease. Nurses Notes: Numerous drugs can alter Platelet production and/or counts. Handle sample gently to avoid platelet clumping. White Blood Cell (WBC) counts > 100,000/mm³ can alter Platelet counts. Name PT Alias Prothrombin Time Normal Values Male 9.6-11.8 Sec. Female 9.5-11.3 Sec. Child 11-14 Sec. Newborn 12-21 Sec. Prothrombin (PT) is a vitamin K dependent protein produced by the liver. Liver disease can lead to increased PT levels. Nursing Notes: Many drugs can falsely elevate or decrease levels. Excessive agitation of sample can increase the PT level. Fibrinogen levels < 100 mg/dL can increase the PT level. Name Iron Alias Normal Values Male 65-175 g/dL Iron (Fe) Female 50-170 g/dL Iron is an important part of erythropoiesis and is necessary for red blood cell maturation and hemoglobin synthesis. Elevated levels are seen with Hemochromatosis and Hepatitis. Nursing Notes: 8 hour fasting sample needed. Ensure medications with iron are withheld for 24 hours prior to test. Handle specimen gently to avoid Hemolysis. Name Alias Normal Values Transferrin Iron Saturation, Total Iron Binding Capacity (TIBC) Adult Transferrin 250-450 mg/dL Adult % Saturation 20-55% Saturation Adult TIBC 300-360 g/dL Protein made by the liver and is responsible for transporting iron through the body. Transferrin and iron form the iron binding capacity. The % Saturation is found by dividing the serum iron level by the TIBC. Iron Studies are frequently ordered with liver disease. Nursing Notes: Hemolysis and iron supplements can affect levels. Many drugs can falsely elevate levels. Name Alias Normal Values Ferritin Part of Iron Panel Male 20-250 ng/dL Female 10-120 ng/dL Protein made by the liver. The amount in circulation is proportional to the amount of storage iron (Ferritin & Hemosiderin) in body tissue. Increased levels are seen with Hemochromatosis & Hepatocellular Disease. Nursing Notes: Recent transfusions can elevate results. Many drugs can elevate level. Levels can be lower during menstruation.