Cirrhosis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Laboratory Findings
The following findings are typical in cirrhosis:
- Aminotransferases - AST and ALT are moderately elevated, with AST > ALT. However, normal aminotransferases do not preclude cirrhosis.
- Alcoholic liver disease - AST and ALT are both elevated but less than 300 IU/L with a AST:ALT ratio > 2.0
- Alkaline phosphatase - Elevated but usually less than two to three times the upper limit. Patients with Primary biliary cirrhosis and Primary sclerosing cholangitis may have higher levels.
- GGT -- correlates with AP levels. Typically much higher in chronic liver disease from alcohol.
- Bilirubin - may elevate as cirrhosis progresses.
- Albumin - levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver
- Prothrombin time - increases since the liver synthesizes clotting factors.
- Globulins - increased due to shunting of bacterial antigens away from the liver to lymphoid tissue which induces immunoglobulin production.
- Serum sodium- hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.
- Thrombocytopenia - due to both congestive splenomegaly as well as decreased thrombopoietin from the liver. However this rarely results in platelet count < 50,000/mL.
- Leukopenia and neutropenia - due to splenomegaly with splenic margination.
- Anemia - multifactorial in origin.
- Acute and chronic GI bleeding
- Folate deficiency
- Direct toxicity of alcohol
- Hypersplenism
- Bone marrow suppression
- Anemia of chronic disease
- Hemolysis
- Coagulation defects - the liver produces most of the coagulation factors and thus coagulopathy correlates with worsening liver disease.
There is now a validated and patented combination of 6 of these markers as non-invasive biomarker of fibrosis (and so of cirrhosis) : FibroTest.[1]
Other laboratory studies performed in newly diagnosed cirrhosis may include:
- Serology for hepatitis viruses, autoantibodies (ANA, anti-smooth muscle,anti-mitochondria, anti-LKM)
- Ferritin and transferrin saturation (markers of iron overload), copper and ceruloplasmin (markers of copper overload)
- Immunoglobulin levels (IgG, IgM, IgA) - these are non-specific but may assist in distinguishing various causes.
- Chronic hepatitis B. Chronic hepatitis B can be diagnosed with detection of HBsAG > 6 months after initial infection. HBeAG and HBV DNA are determined to assess whether patient will need antiviral therapy.
- Cholesterol and glucose
- Alpha 1-antitrypsin
References
- ↑ Halfon P, Munteanu M, Poynard T (2008). "FibroTest-ActiTest as a non-invasive marker of liver fibrosis". Gastroenterol Clin Biol. 32 (6): 22–39. doi:10.1016/S0399-8320(08)73991-5. PMID 18973844.