Liver Function Blood Test - Procedure Indication, Levels, Cost
At PACE Hospitals, we are equipped with state-of-the-art diagnostic laboratory accredited by NABL (National Accreditation Board for testing and Calibration Laboratories) to carryout blood test for liver function and interpretation of LFT results done medical experts.
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What is Liver Function Test ?
LFT full form - Liver Function Test
Liver function tests are a chain of blood tests done to evaluate and monitor the treatment of hepatic dysfunction. The liver metabolises carbs, proteins, and lipids. The enzymes and metabolic pathway end products function as markers of liver function. When liver function is impaired, the biochemical markers demonstrate the extent of liver damage. The biochemical markers include:
- Total, Direct & Indirect Bilirubin
- Alanine aminotransferase (ALT/SGPT)
- Aspartate aminotransferase (AST/SGOT)
- Ratio of aminotransferases - AST/ALT Ratio
- Alkaline phosphatase (ALP)
- Gamma-glutamyl transpeptidase (GGT)
- Total Protein
- Serum albumin
- Serum Globulin
- Albumin / Globulin (A/G) Ratio
Apart from the above list doctors also suggest these blood test to check Prealbumin, Ceruloplasmin, Alpha-Fetoprotein (AFP), Lactate Dehydrogenase (LDH), 5' nucleotidase, Prothrombin time (PT), International normalised ratio (INR).
Many biomarkers in liver function tests don't mention the exact liver function, but rather highlight the extent of the damage.
Liver function test indication
The indication of liver function blood tests usually include the following:
- Screening: They are prescribed as a sensitive screening modality for liver dysfunction in suspected and high-risk individuals.
- The pattern of disease: Liver function tests are helpful to recognise the way of liver disease, e.g., differentiating between acute viral hepatitis and various cholestatic disorders and chronic liver disease.
- Assess severity: They are helpful in assessing the severity and predicting the outcome of certain diseases like primary biliary cirrhosis.
- Follow-up: They are helpful in the follow-up of certain liver diseases and valuable for evaluating responses to therapy like autoimmune hepatitis.
Abnormal liver function tests may indicate subclinical liver disease, guiding additional diagnostic examination. After hepatic dysfunction is identified, liver test abnormalities may imply the underlying liver illness, such as hepatitis, biliary obstructions, or infiltrative liver disease.
Blood test for liver function may not be cost-effective for screening healthy, asymptomatic people for liver disease. A panel of tests (aspartate aminotransferase, alkaline phosphatase, bilirubin, albumin) is preferred to a single test for screening since it is more sensitive and specific for liver disease.
Liver function test normal range chart - normal values
| Parameter | Normal range |
|---|---|
| Total Bilirubin | 0.2 to 1.2 mg/dl |
| Direct Bilirubin | 0.0 to 0.3 mg/dl |
| Indirect Bilirubin | 0.2 to 0.7 mg/dl |
| ALT / SGPT | 5 to 40 IU/L |
| AST / SGOT | 5 to 40 IU/L |
| AST / ALT Ratio | <1 |
| Alkaline Phosphatase (ALP) | 70 to 110 U/L |
| Total Protein | 6.4 to 8.3 gm/dl |
| Serum Albumin | 3.5 to 5.2 gm/dl |
| Serum Globulin | 2.0 to 3.5 gm/dl |
| Albumin / Globulin (A/G) Ratio | 1 to 2 |
Liver function test interpretations
The liver function blood test results for the normal range may differ very slightly (maybe by one or two units) when compared with different healthcare centres.
Bilirubin: Around 80% of bilirubin is produced from haemoglobin. Albumin (a protein found in the blood) transports unconjugated bilirubin to the liver. Bilirubin is water-insoluble and not eliminated in the urine, but conjugated bilirubin is urine-soluble. In the liver, it's converted to bilirubin glucuronide which forms the major part of bile. The following may cause mild elevation in bilirubin ranges:
- Liver diseases
- Physiological clearance jaundice
- Inherited hyperbilirubinemias etc.
The following may cause moderate elevation in bilirubin ranges:
- Extrahepatic biliary atresia
- Intrahepatic biliary atresia
- Drugs induced liver impairment
- Viral hepatitis and
- Inherited hyperbilirubinemia
Alanine aminotransferase (ALT/SGPT): Alanine aminotransferase is a liver-derived enzyme. Hepatocellular damage, not cell death, induces enzyme release. Males have greater alanine aminotransferase than females. Alanine aminotransferase is linked with obesity; obese people have a greater normal range compared with healthy-weight people. The following may cause moderate elevation in alanine aminotransferase ranges:
- Hepatitis
- Autoimmune
- Toxic, neonatal hepatitis etc
Aspartate aminotransferase (AST/SGOT): Both aspartate aminotransferase and alanine aminotransferase are hepatocellular injury markers. Aspartate aminotransferase is found in the liver and cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lungs, leucocytes, and red blood cells. It's not as sensitive or specific for the liver as the alanine aminotransferase. Elevated aspartate aminotransferase may have non-hepatic origins. Neonatal and infant aspartate aminotransferase activity is double that of adults but drops to adult levels at six months. Males have greater aspartate aminotransferase than females. The following may cause moderate elevation in aspartate aminotransferase ranges:
- Hepatitis
- Autoimmune, toxic, neonatal hepatitis
The ratio of Aspartate aminotransferase to Alanine aminotransferase (<1): Research from the last few decades demonstrated that role of aspartate aminotransferase to (AST): alanine aminotransferase (ALT) ratio in the differentiation of alcoholic liver disease (ALD) from other forms of liver disease, especially the Non-alcoholic Fatty Liver Disease (NAFLD). A normal AST: ALT ratio should be <1.
- In patients with moderate to mild alcoholic liver disease, the AST: ALT ratio is >1.
- In severe alcoholic liver disease, the AST: ALT scores are >2.
- In NAFLD and Non-alcoholic Steatohepatitis (NASH), the AST: ALT ratio is <1.
Alkaline phosphatase: Alkaline phosphatase is a zinc metalloenzyme found in bile and other tissues such as bone, intestines, and the placenta. Alkaline phosphatase can markedly be increased, indicating disease, but in the case of benign, it returns to normal after 6–8 weeks. Benign transitory hyperphosphatasaemia (excess of alkaline phosphatase in the blood) increases plasma alkaline phosphatase. Transient hyperphosphatasaemia may develop in adults and during pregnancy. In about 60% of cases, transient hyperphosphatasaemia is related to gut infections.
- Liver disease cause mild elevation in while extrahepatic biliary atresia, intrahepatic biliary atresia, infiltrating disorders, granulomatous hepatitis may cause moderate elevations in alkaline phosphatase ranges
Total protein: Proteins are vital building blocks of every cell and tissue in the body. Globulin and albumin are two types of protein found in your body. The total protein test checks how much albumin and globulin you have in the body as a whole. It can be done-
- as a part of a regular check-up
- to find out any there is an unexpected weight loss
- to find the reason for fatigue (feeling tired all the time)
- to understand if the patient is suffering from any kidney or liver disease
Serum globulin: A globulin blood test checks the amount of globulins in the blood serum. Globulins are a group of proteins produced by the immune system and the liver. The three types of globulins (alpha, beta, and gamma globulins) are about 40% of the proteins in the blood. Serum globulin is prescribed by the doctor if the patient is presented with the following:
- Oedema (fluid build-up) in the stomach or lower limbs
- Jaundice (yellow discolouration of the skin)
- Fatigue (feeling tired all the time)
- Anorexia (loss of appetite)
- Nausea and vomiting
- Pruritus (itchy skin)
- Malnutrition
Gamma-glutamyl transpeptidase (GGT): Gamma (γ) Glutamyl transpeptidase is found in large amounts in organs such as kidneys, pancreas, liver, gut, and prostate, but its abnormal levels are still attested to liver impairment. Glutamyl transpeptidase levels are high in newborns and babies up to 1 year and increase beyond 60 years. Men have higher values than women. Children above 4 have adult serum levels.
- The mild and moderate elevations of γ glutamyl transpeptidase are similar to those of alkaline phosphatase.
- Raised in extrahepatic biliary atresia, progressive familial intrahepatic cholestasis
Serum albumin: Albumin, a useful indicator of hepatic function, is also the most importantplasma protein produced by the liver. Albumin production impairment can also be due to nutritional status, hormonal balance and osmotic pressure and not exclusively by liver disease
- Altered levels of prothrombin time could mean the presence of cirrhosis and chronic liver disease
- Ascites can be expected with lower serum albumin levels
Prealbumin: Prealbumin protein is synthesised in the liver, which helps transport Vitamin A and thyroid hormones through the bloodstream. Prealbumin also helps in the regulation of energy usage
- Altered levels of prothrombin time could mean the presence of drug-induced hepatotoxicity
Serum ceruloplasmin: Ceruloplasmin is an acute-phase protein synthesised in the liver. A major copper-carrying protein in the blood, ceruloplasmin also plays a role in the metabolism of iron. Elevated levels of ceruloplasmin could demonstrate the presence of -
- Wilson's disease
- Menke’s disease
- Kwashiorkor
- Marasmus
- Protein-losing enteropathy
- Copper deficiency infections
- Rheumatoid arthritis
- Pregnancy
- Non-Wilson liver disease
- Obstructive jaundice and aceruloplasminemia
Alpha-fetoprotein (α-fetoprotein): α-fetoprotein is synthesised in the liver necessary for the growth and division of hepatocytes to make new cells. While α-fetoprotein is high in unborn babies, after birth, the levels drop. Healthy non-pregnant adults and children have very little α-fetoprotein in their blood. Elevated levels of α-fetoprotein could demonstrate the presence of -
- Liver cancer
- Ovarian cancer
- Testicular cancer
- Lymphoma and/or
- Lung cancer
5'-nucleotidase (5'-NT): 5'-Nucleotidase is an intrinsic membrane glycoprotein in the liver, heart and skeletal muscle. It is useful for differential diagnosis of Increased hepatobiliary levels of 5’-nucleotidase activity seen in obstructive jaundice patients, parenchymal liver disease, hepatic metastases and bone disease. 5'-nucleotidase is also a precise marker of early hepatic primary or secondary tumours.
- The mild and moderate elevations of 5’-nucleotidase are similar to those of alkaline phosphatase and γ glutamyl transpeptidase
Prothrombin time (PT): The prothrombin time calculates the time taken for prothrombin to convert into thrombin (enzyme-promoting coagulation).
- Altered levels of prothrombin time could mean the presence of acute/chronic liver disease, which is non-responsive to vitamin K.
- It could also mean the presence of extrahepatic biliary atresia / biliary obstruction, which is responding to vitamin K administration.
International normalised ratio (INR): Every unit of increase corresponds to the increased time taken to clot (blood is becoming thinner). In the case of serious liver disease and cirrhosis, the production of proteins is hampered, resulting in impaired blood clotting. The international normalised ratio is related to the prothrombin time.
- The causes of altered levels of international normalised ratio are similar to prothrombin time.
Lactate Dehydrogenase (LDH): Lactate dehydrogenase is an enzyme found in most of the body's tissues, such as the heart, kidneys, brain, and lungs. It has an important role in energy extraction. Damaged tissues release high amounts of lactate dehydrogenase into the bloodstream. Elevated levels of lactate dehydrogenase could mean
- Meningitis
- Lymphoma
- Pancreatitis
- Heart attack
- Encephalitis
- Lung cancer
- Liver disease
- Ovarian cancer
- Kidney disease
- Testicular cancer
- Infectious mononucleosis (mono)
Factors that could interfere with liver function test
Haemolysis (the rupture of red blood cells), icterus (bile deposition in the skin during jaundice), and lipemia (the presence of excess fats/lipids in the blood) are the most common factors interfering with laboratory tests.
Liver function test procedure
The doctor may recommend a liver function blood test to an individual in order to understand his/her chances of getting a liver disease for a variety of reasons, especially if the patient falls under a potential risk population such as:
- Diabetics
- Hypertensives
- Obese individuals
- Patients suffering from lupus,
- Any cancer patients, especially colon cancer,
- Alcoholics etc
The doctor can also prescribe blood test for liver function to monitor the ongoing treatment/prognosis in patients with liver disease, such as:
- Liver inflammation – to understand the history of hepatitis
- Liver cancer
- Liver injury
- Liver transplant
- Infectious hepatitis,
- Liver cirrhosis (end-stage liver disease), etc
Upon observing the sign and symptoms and taking the subjective evidence from the patient, the doctor may prescribe a blood test for liver function.
Before the liver function test
- The patient is supposed to ask questions regarding the test to the doctor and get doubts rectified.
- The payment for the test must be made.
- Around 10-12 hours of fasting is necessary before attending the test.
- Since the test is usually done on the arm, a short-sleeved or sleeveless shirt is better.
During the liver function test
- Upon reaching the specimen collecting lab in the hospital, the phlebotomist (technician) sterilises the area on the patient’s body through which the blood is extracted to avoid any nosocomial (hospital-acquired) infection at the puncture site.
- A tourniquet will then be tied around the arm (above the elbow) to facilitate the visibility of veins and blood pooling.
- A clean, sterilised hypodermic needle is utilised to extract blood (appropriately 5 ml) collected in a sterilised tube.
After the liver function test
- Once the blood is extracted, a small piece of cotton may be provided by the phlebotomist to arrest the bleeding. In some centres, medical plaster may be applied to achieve the same result.
- The patient is advised to retain the arm in the folded position for 2-5 min.
- The patient is then free to leave and break the fasting.
- The patient may need to refrain from lifting heavy objects for at least 24 hours.
- Very rarely, complications may arise, such as fatigue, bleeding, bruising, or soreness at the site. In case of severe cases, medical consultation must be done.
Liver function test in pregnancy
Liver function tests are a part of the common tests done during pregnancy to understand and correct the course of a healthy pregnancy. Pregnancy-related illnesses are the most common cause of abnormal liver function tests during pregnancy, especially in the third trimester. The most prevalent is the pre-eclampsia-related condition (high blood pressure during pregnancy).
The others include:
- Sickle cell disease (hereditary anaemia with crescent-shaped red blood cells)
- Hepatitis (inflamed liver)
- Acute fatty liver of pregnancy (excess fat accumulation in the liver during pregnancy)
- HELLP syndrome (a serious complication of high blood pressure during pregnancy)
- To confirm a diagnosis during pregnancy, the following are of vital importance
- The age of pregnancy
- The levels of various liver function tests (for both pregnancy-specific and pregnancy-non-specific illnesses)
Liver function test and diabetes
Liver function test can't detect diabetes. Patients with type 2 diabetes tend to have liver function blood test abnormalities when compared with non-diabetic patients. This could be due to the underlying insulin resistance.
On the other hand, it was shown that antidiabetic agents administration showed a reduction in alanine aminotransferase levels with normalised blood glucose levels.
Protein in liver function test
The main cause of protein deficiency is decreased dietary intake, inefficient digestion and absorption (especially in alcoholic liver disease).
Liver function blood test can be done to acknowledge the protein levels for any supplementation during therapy. Liver function test can also useful in finding the protein and vitamin deficiencies during hepatic regeneration following hepatic resection or injury.
Urine test and Liver function
A Complete Urinalysis, a test that evaluates various cells, chemicals, and other compounds in the urine, often includes a bilirubin in urine test. The overall health may be checked with a urine test often.
Generally, urine doesn't contain any bilirubin, if there is bilirubin in urine that can indicate early sign of liver disease and malfunction.
Frequently asked questions:
What are the risks of liver function tests?
Liver function blood test is a minor test with having no risks associated.
What are the contraindications of liver function test?
Puncture must not be done in any site with residual scar tissue due to previous attempts. The other contraindications include the following:
- Cellulitis (inflammation of subcutaneous connective tissue)
- An abscess (a painful collection of pus, usually due to a bacterial infection)
- Vascular graft (surgical procedure redirecting blood from one region of the body to another by reconnecting the blood vessels)
- Hematoma (increased swelling of clotted blood within the tissues)
- Venous fibrosis (blood clot formed in any superficial vein)
What are the limitations of liver function test?
There are a few parameters that liver function blood tests may fail to show due to a lack of sensitivity and specificity. In such scenarios, other tests could support the confirmation of diagnosis. The limitations of liver function can be broadly divided into two types.
Limitations due to lack of sensitivity: Blood test for liver function may sometimes be normal in certain liver diseases like cirrhosis, non-cirrhotic portal fibrosis, congenital hepatic fibrosis, etc.
Limitations due to lack of specificity: Blood test for liver function may lack specificity in certain diseases.
- Serum albumin may be decreased in chronic disease and also in nephroticsyndrome.
- Amino transferases may be raised in cardiacdiseases and hepatic diseases.
- Except for serum bile acids, blood test for liver function is not specific forliver diseases, and all the parameters may be elevated forpathological processes outside the liver.
Which test is most accurately diagnosed with cirrhosis?
Liver function tests, a complete blood count with platelets, and a prothrombin time test should be conducted if a liver problem is suspected. However, no blood test can identify
cirrhosis reliably. Only through the amalgamation of all the information from signs and symptoms, liver function blood tests and other imaging tests can cirrhosis be confirmed.
Can dehydration affect liver function tests?
Yes. Dehydration affects liver function tests, which are why the knowledge of the hydration status of the patient is necessary for the doctor before interpreting the results. Patients must avoid unnecessary physical activity, hot, dry environments and any diuretic (urine-inducing) substances such as caffeine. The patient can nevertheless have ample water.
Does Covid affect LFT (Liver function test)?
Yes. COVID can affect LFT (liver function blood test). A study in 2021 demonstrated that it is common in COVID positive patients to obtain abnormal liver function tests, especially in severe COVID. Monitoring liver function blood tests is highly recommended, particularly in the elderly and severe COVID patients.
How does obesity affect liver function?
Obesity is a significant predictor of abnormal liver function test results in children and young people. However, it is less recognised as a risk factor for children's liver disease than young adults. It was demonstrated that raised BMI was an independent predictive factor for liver function blood testing in young adults (ages 18 to 25 years) but surprisingly not in children (ages 10 to 17 years).
What is A/G Ratio in liver function test?
A/G ratio stands for Albumin/Globulin ratio, which is a blood test to calculate the levels of protein in the body. The normal range for Albumin/Globulin (A/G) ratio is usually around 1 to 2.
As the liver makes most of the proteins (globulin and albumin) that are found in the blood. While albumin is necessary for the transport of various substances around your system, globulin use is seen in the routine functioning of the liver, blood clotting, and fighting infection.
This test provides the amount of albumin compared with globulin. This information is useful for the healthcare provider in the diagnosis of liver or kidney disease.
What is SGOT and SGPT in liver function test?
SGPT and SGOT are the important enzymes which is produced by the liver and are vital in finding the extent of liver impairment. SGPT stands for serum glutamic-pyruvic transaminase and SGOT stands for serum glutamic-oxaloacetic transaminase. Now a days SGOT is being called as AST (aspartate aminotransferase) and SGPT is being called ALT (alanine aminotransferase).
What does high protein in liver function test mean?
High protein levels in liver function test could mean the following:
- HIV (human immunodeficiency virus) - a viral attack on the immune system
- Viral hepatitis - a viral attack on the liver
- Myeloma multiple - a form of blood cancer
Do you need to fast for liver function test?
No. Fasting is not necessary for liver function tests, but it is generally observed that fasting enhances the results of liver function tests. This is why it is advised to fast for at least 10-12 hours before taking the nest. Nevertheless, anyone can visit the hospital at any time to give a blood sample for LFT test.
What is liver function test price in India?
Average price of liver function test in India is approximately ₹ 850 (eight hundred fifty only). However, liver function test price in India may vary from ₹ 650 to ₹ 1,150 (six hundred fifty to one thousand one hundred fifty) in different private hospitals, different diagnostic centers from different cities.
What is liver function test cost in Hyderabad?
Liver function test cost in Hyderabad ranges vary from ₹ 750 to ₹ 1100 (seven hundred fifty to one thousand one hundred) in different diagnostic centers and private hospitals.
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