Acute liver failure laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged by ≈ 4-6 seconds or more (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of ALF should be strongly suspected and hospital admission is mandatory.

Laboratory Findings

LAB	values in Acute liver failure	Comments
Prothrombin time/INR	Increased	Prolonged prothrombin time, resulting in an INR ≥1.5; it shows coagulopathy which is a part of acute liver failure criteria.
Hemoglobin
Liver function tests AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin
Blood glucose
Amylase and lipase
Arterial blood gas, lactate
Acetaminophen level, Toxicology screen
Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels
Ceruloplasmin Level ( when Wilson's disease suspected)
Pregnancy test (females)
Ammonia (arterial if possible)
HIV status (has implication for transplantation)

Initial laboratory examination must be extensive in order to evaluate both the etiology and severity..

Initial laboratory analysis

• Prothrombin time/INR
• Complete blood count
• Chemistries
  • Liver function test: AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin
  • Creatinine, urea/blood urea nitrogen, sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate
  • glucose
  • Amylase and lipase
• Arterial blood gas, lactate
• Blood type and screen
• Paracetamol (Acetaminophen) level, Toxicology screen
• Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
• Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels
• Ceruloplasmin Level ( when Wilson's disease suspected)
• Pregnancy test (females)
• Ammonia (arterial if possible)
• HIV status (has implication for transplantation)