LABORATORY DATA INTERPRETATION

Liver function tests

 Performed to assess the state of liver’s health
 Not always accurate indicator of liver function
 More so they are indicator of hepatocyte damage
 Enzymes are present in these cells and rise in their level is indicative of lysis
 Extent to which these numbers are high are indicative of the severity of
damage
 Commonly used LFTs are gamma glutamyl transferase, alkaline phosphatase,
lactate dehydrogenase, alanine aminotransferase, and aspartate
aminotransferase
 Liver function test
 Serum bilirubin is a breakdown product of
heme, a component of hemoglobin in red
blood cells
 The liver plays a crucial role in processing
bilirubin. There are two main types of
bilirubin measured in a blood test:
 Unconjugated bilirubin (indirect
bilirubin): This is the fat-soluble,
insoluble form produced by the
breakdown of red blood cells. It's
transported in the blood bound to
albumin protein.
 Conjugated bilirubin (direct bilirubin):
This water-soluble form is processed by
the liver and excreted in bile
 Liver function test
 Gamma-glutamyl transferase (GGT) is an enzyme found in the liver, bile
ducts, kidneys, and pancreas. While not as specific as other liver function
tests, elevated GGT levels can indicate potential liver or biliary problems
 Elevated GGT
 Liver disease: Hepatitis, cirrhosis, or bile duct obstruction can cause
increased GGT.
 Alcohol abuse: Chronic alcohol consumption is a major cause of
elevated GGT.
 Medications: Certain medications can increase GGT levels, so a
medication history review is crucial.
 Other conditions: Obesity, metabolic syndrome, and some cancers can
also elevate GGT
 Liver function test
 Alkaline phosphatase (ALP) is an enzyme found in various tissues throughout
the body, with high concentrations in the liver, bones, and bile ducts. While
not specific to the liver, ALP levels can be a helpful marker for diagnosing and
monitoring certain conditions.
 Elevated ALP:
 Liver disease: Hepatitis, cirrhosis, or bile duct obstruction can cause
increased ALP due to damage or reduced bile flow.
 Bone disorders: Growing children, Paget's disease, bone fractures, or bone
tumors can elevate ALP due to increased bone formation or turnover.
 Other conditions: Pregnancy, certain medications, and some cancers can
also elevate ALP.
 Liver function test
 Lactate dehydrogenase (LDH) is an enzyme found in various tissues throughout
the body, including muscles, liver, kidneys, red blood cells, and lungs. An LDH test
measures the total amount of LDH in the blood. While not specific to one organ,
elevated levels can indicate cell damage in various tissues
 Elevated LDH:
 Muscle damage: strenuous exercise, injuries, or muscle diseases can cause LDH
release from muscle cells.
 Liver disease: Hepatitis, cirrhosis, or other liver problems can damage liver cells
and release LDH.
 Hemolysis: Breakdown of red blood cells can release LDH into the bloodstream.
 Kidney disease: Severe kidney damage can also lead to elevated LDH.
 Cancers: Some cancers, like lymphoma, can cause increased LDH.
 Liver function test
 Alanine aminotransferase (ALT), also sometimes called SGPT (serum glutamic-
pyruvic transaminase), is an enzyme found primarily in the liver. An ALT blood test
measures the amount of ALT in the bloodstream. When liver cells are damaged,
they leak ALT into the bloodstream.
 Elevated ALT level: Can indicate various liver problems:
 Viral hepatitis: Hepatitis A, B, or C can cause ALT elevation.
 Alcoholic liver disease: Excessive alcohol consumption damages the liver and
raises ALT.
 Non-alcoholic fatty liver disease (NAFLD): Fat buildup in the liver (NAFLD) can
elevate ALT, especially in its advanced stages (NASH).
 Drug-induced liver injury (DILI): Certain medications can damage the liver and
cause ALT elevation.
 Autoimmune hepatitis: The immune system attacks the liver, leading to
inflammation and potentially elevated ALT.
 Liver function test
 Aspartate aminotransferase (AST), also sometimes called SGOT (serum glutamic-
oxaloacetic transaminase), is an enzyme found in the liver, heart, muscles,
kidneys, and other tissues. An AST blood test measures the amount of AST in the
bloodstream
 Elevated AST level: Can indicate damage in various organs:
 Liver: Similar to ALT, AST elevation can occur in various liver diseases like
hepatitis, alcoholic liver disease, NAFLD, or drug-induced liver injury (DILI).
 Heart: Heart attack, heart muscle inflammation (myocarditis), or unstable
angina can cause AST elevation.
 Muscles: Muscle injury, strenuous exercise, or certain muscle diseases can
increase AST levels.
 Kidneys: Severe kidney damage can sometimes elevate AST
 Liver function test
 AST vs. ALT:
 While both enzymes are elevated in liver injury, ALT is more specific to the liver.
 In most liver diseases, ALT levels tend to be higher than AST levels.
 If AST is significantly higher than ALT, it may suggest damage outside the liver,
such as muscle injury or heart problems
 Blood glucose
 FBG = 70-110 mg/dL
 RBG = <200mg/dL
 Common cause is diabetes mellitus
 Since blood glucose elevation is not always due to diabetes as it is
mostly dependent on CHO intake
 Results should be interpreted with food intake
 FBG is more indicative of impaired glucose metabolism
 Alternatively, glucose tolerance test is also used for diagnosis
 Blood glucose
 BGL is a means to monitor response treatment for diabetes
 Aim of treatment is to maintain levels close to higher range
 In older patients it is not advised to use strict control of BGL, as that
may lead to hypoglycemia
 In younger patients however strict control is advised
 Long term diabetes is monitored by measuring glycosylated
hemoglobin or Hb A1C
 Less than 7% of total Hb indicates that BGL over the 3 months
preceding the test has been remarkable
 Cardiac Markers
 Cardiac markers are substances released into the bloodstream following
damage or stress to the heart muscle. These markers are measured in
blood tests to aid in the diagnosis, risk assessment, and sometimes to guide
treatment decisions for various heart conditions, particularly acute coronary
syndrome (ACS).
 Cardiac Markers:
 Troponin: Considered the most specific and sensitive marker for
myocardial injury.
 Troponin levels typically rise within 3-6 hours of a heart attack, peak
within 1-2 days, and remain elevated for up to 10 days.
 Elevated troponin levels are strong indicators of myocardial injury and
require further investigation.
 Cardiac Markers
 Creatine Kinase (CK) and Creatine Kinase-MB (CK-MB):
 CK is a general enzyme found in various muscles, including the heart. CK-
MB is a specific fraction of CK found primarily in the heart.
 While CK levels can rise after heart damage, they are less specific than
troponin as CK can also be elevated due to muscle injury elsewhere in the
body.
 CK-MB is more specific to the heart but may not be as sensitive as
troponin, especially in milder cases of myocardial injury.
 Other Markers:
 Myoglobin: An early marker released quickly after heart damage, but not
very specific as it can also be elevated with other muscle injuries.
 B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP):
Primarily used for diagnosing heart failure, but may also be elevated in
ACS