Lab Tests

Some lab tests are done after you’ve been diagnosed with liver damage. Other tests will continue on a regular basis. These tests will monitor your health and help you and your doctor decide what treatment is best for you, and if it’s working.

Regular Lab Tests

ALP (Alkaline Phosphatase or Alk-Phos)

Normal Level in Adults: 30 – 130 U/L (Units Per Litre)

Alkaline phosphatase is also called ALP, or more commonly, alk-phos. It’s an enzyme produced in liver cells and in your liver’s bile ducts. The test for alk-phos is typically part of a liver panel.

Explanation of Test Results

  • High alk-phos occurs when there’s a blockage within your bile ducts, or when there’s a buildup of pressure in your liver. These conditions are often caused by a gallstone or scarring in the bile ducts.
  • Alk-phos is produced in other organs besides your liver. It’s also found in your bones and kidneys. It doesn’t necessarily reflect liver damage or inflammation.
ALT (Alanine Aminotransferase)

Normal Level in Adults: 7 – 40 U/L (Units Per Litre)

ALT is one of many liver enzymes. It’s useful to detect ongoing activity like inflammation in your liver. When your liver cells are damaged, ALT leaks into your bloodstream, reaching a higher-than-normal level. ALT is a reasonably specific indicator of liver status.

Explanation of Test Results

  • High ALT often means you have some liver damage, but it doesn’t show exactly how much. ALT won’t indicate the amount of scarring (fibrosis) in your liver, and it won’t predict how much liver damage may develop.
  • ALT can rise and fall in small increments in most people. This doesn’t mean the liver is functioning better or worse. However, people can have cirrhosis and other severe liver disease and still have a normal ALT level.

(Note: ALT is also known as alanine transaminase.)

AST (Aspartate Aminotransferase)

Normal Level in Adults: 5 – 40 U/L (Units Per Litre)

AST is another enzyme made by liver cells. Like ALT, AST leaks into your bloodstream when liver cells are damaged, reaching higher-than-normal levels. Unlike ALT, AST is also in other parts of your body including your heart, kidneys, muscles, and brain. When cells in any of these body parts are damaged, AST can be elevated.

Explanation of Test Results

  • High AST often means you have some liver damage. But high AST with a normal ALT may mean the AST is coming from a different part of your body.
  • AST doesn’t show exactly how much liver damage you might have or if your liver is getting better or worse. Normally, small changes in AST levels can be expected.
  • As with ALT, people can have cirrhosis and other severe liver disease and still have a normal AST level.
  • People with hepatitis C may see their AST levels fluctuate.

(Note: AST is also known as aspartate transaminase.)

Bilirubin

Normal Level in Adults: Less Than 20 (µmol/L)

Bilirubin is a yellowish substance in the blood created by the breakdown (destruction) of hemoglobin, a major component of red blood cells.

As red blood cells age, they break down naturally in your body. These destroyed cells release hemoglobin, which is converted to bilirubin. The bilirubin then passes on to your liver. Your liver excretes bilirubin in fluid called bile. If your liver is malfunctioning, it won’t excrete bilirubin properly.

High levels of bilirubin can cause jaundice: yellowing skin and eyes, darker urine, and lighter-coloured bowel movements.

Explanation of Test Results

  • If your bilirubin level is higher than normal, it may mean that your liver is not working properly.
  • When bilirubin remains high for prolonged periods, it usually indicates severe liver disease and possibly cirrhosis.
  • Elevated bilirubin levels can be caused by reasons other than liver disease.
INR

Normal Level in Adults: 1.0

An INR test measures how quickly your blood forms a clot compared with normal clotting time. You may also hear INR called PT (prothrombin time) or PT INR. These are all the same test.

Explanation of Test Results

  • In cases of serious liver disease and cirrhosis, your liver may not produce the normal amount of proteins. Then your blood can’t clot normally. Each INR increase of 0.1 above the norm means the blood is slightly thinner and taking longer to clot.
  • High INR usually means your liver isn’t working at its best because it’s not supporting normal blood clotting.
  • Some cirrhosis patients take a drug called Coumadin (warfarin), which elevates INR for the express purpose of “thinning” the blood.
Albumin

Normal Level in Adults: 35 – 50 g/L (Grams Per Litre)

Albumin is a common protein found in the blood and produced only in your liver. It has a variety of functions, one of which is to prevent fluid leaking from blood vessels into tissues.

If your albumin levels are lower than normal, it can suggest chronic liver disease or cirrhosis. Many conditions other than liver disease may also cause low albumin levels.

Explanation of Test Results

  • Albumin levels can fluctuate slightly in a healthy liver, but low albumin usually indicates cirrhosis (advanced liver disease).
  • Low albumin can also result from kidney disease, malnutrition, or other acute illnesses.
  • Very low albumin can cause edema, which means fluid buildup in the legs. When this fluid buildup occurs in your abdomen, it’s called ascites.
Creatinine

Normal Level in Adults: 50 – 120 (µmol/L)

Creatinine comes from the breakdown of muscle protein. It’s a body marker of kidney function. Properly functioning kidneys remove creatinine from the blood.

When creatinine levels rise gradually, there aren’t usually any symptoms. Only lab tests will detect higher levels.

Explanation of Test Results

  • High creatinine means your kidneys aren’t functioning normally. This is sometimes called renal insufficiency. It can be caused by certain medications, dehydration, too high a dose of diuretics (water pills), or advanced liver disease (cirrhosis).
Electrolytes

Electrolytes are chemicals in your body such as sodium and potassium. Your electrolyte levels must be checked often when your healthcare provider prescribes diuretics (water pills).

Hemoglobin

Normal Levels

Adult Males: 140 – 180 g/L (Grams Per Litre)

Adult Females: 120 – 160 g/L (Grams Per Litre)

Hemoglobin is a protein in red blood cells. It enables these cells to carry oxygen throughout your body.

Explanation of Test Results

  • This blood test will register very low if you have internal bleeding.
Platelets

Normal Level in Adults: 150 – 300 (109/L)

Platelets are cells that initiate the formation of blood clots. Labs measure platelet count as part of the complete blood count (CBC).

Explanation of Test Results

  • Platelet counts in cirrhosis patients are often low. But low platelet counts can also come from other causes, including certain medications.
  • When platelet count is reduced, this is known as thrombocytopenia. If you have too low a platelet count, you can’t produce normal clots and may bruise more easily.
White Blood Cells (WBCs)

Normal Level in Adults: 4 – 11 (109/L)

White blood cells (WBCs) are produced in the bone marrow, which is in the centre of many bones.

There are five main types of WBCs:

  • basophils
  • eosinophils
  • lymphocytes
  • monocytes
  • neutrophils

Each does a slightly different job, but all of them help fight infection.

Explanation of Test Results

  • Low WBC count may be caused by cirrhosis, alcohol use, medications, or other medical conditions.
  • High WBC count may indicate infection.

Other Tests Relating to Cirrhosis

AFP (Alfa-Fetoprotein)

AFP is a protein present in people with liver disease. It’s also a tumor marker and may be used to test for liver cancer.

Explanation of Test Results

  • High AFP might mean the presence of liver cancer.
  • Sometimes AFP is high when there’s no cancer, but it can indicate active liver disease instead.
  • High AFP should be interpreted by your doctor. It can be high because of other types of cancer or because of a normal pregnancy. Or, it may just mean you have an active liver.
  • Usually, a doctor will interpret the AFP test along with images of your liver taken by ultrasound, CT scan, or MRI.
Total Protein

Total protein level measures a number of different blood proteins. It can be divided into the albumin and globulin fractions.

Explanation of Test Results

  • Low total protein levels can occur because of impaired liver function.

Hepatitis Tests

Hepatitis A Antibody Total

A positive result means you’ve been infected with hepatitis A in the past or were vaccinated against hepatitis A. Therefore, you’re immune from hepatitis A infection in the future.

Hepatitis B Core Antibody (Anti-HBc)

Explanation of Test Results

  • A positive test result for Anti-HBc means you’ve been exposed to hepatitis B and have developed an antibody to just one part of the virus. This antibody does not give you immunity.
  • You need more tests to find out if you have the disease.
Hepatitis B e Antigen (HBeAg)

Explanation of Test Results

  • A positive test result for HBeAg means you may have very active hepatitis B and should be followed closely by your doctor. You may also need to take hepatitis B medications.
  • You may be very contagious to others.
Hepatitis B Surface Antibody (Anti-HBs or HBsAb)

Explanation of Test Results

  • A positive test result shows you have antibodies to hepatitis B and are immune to this virus.
  • This could be from a natural infection or vaccination.
Hepatitis B Surface Antigen (HBsAg)

Explanation of Test Results

  • A positive test result for HBsAg shows you are actively infected with hepatitis B.
  • Your infection could be acute (a recent infection) or chronic (been there a long time, even decades).
  • You could infect others, especially sexual partners.
Hepatitis C Antibody (Anti-HCV)

Explanation of Test Results

  • A positive result for Anti-HCV means you’ve been exposed to the hepatitis C virus. Another important test, an HCV RNA, must then be performed to find out if the virus is still in your body.
  • Being positive for the Anti-HCV test does not mean you’re immune. You could be infected with hepatitis C again.
Hepatitis C RNA (HCV RNA)

Explanation of Test Results

  • If your Anti-HCV test is positive, your healthcare providers will perform the HCV RNA test next to see if you still have the virus in your body.
  • A positive test result for HCV RNA means you have chronic hepatitis C. You may develop health problems from the virus.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021
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