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Liver Profile (LFT)

Liver

11 parameters

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Report in 4Hrs

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Fasting Required

Details

Panel of liver enzymes, proteins, bilirubin.

₹219₹399

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Parameters

  • List of Tests
    • Albumin
    • Alkaline Phosphatase
    • Bilirubin Direct
    • Bilirubin Indirect
    • Bilirubin Total
    • AST or SGOT
    • ALT or SGPT
    • Total Protein
    • A/G Ratio
    • Gamma GT
    • Globulin

Liver Profile (LFT) - Comprehensive Medical Guide

  • Why is it done?
    • The Liver Profile is a comprehensive panel of tests that evaluates overall liver function and hepatic health by measuring enzymes, proteins, and bile metabolism products
    • Detects liver damage, inflammation, and disease through measurement of liver enzymes (AST, ALT, Alkaline Phosphatase, Gamma GT) and assesses hepatic synthetic function via protein markers (Albumin, Total Protein, Globulin)
    • Evaluates bile metabolism and cholestasis through bilirubin measurements (Total, Direct, and Indirect bilirubin)
    • Ordered to screen for acute or chronic liver disease including hepatitis, cirrhosis, fatty liver disease, and cholestasis
    • Used to monitor patients taking hepatotoxic medications (methotrexate, statins, acetaminophen, antiretrovirals) or with known liver conditions
    • Indicated for patients presenting with jaundice, abdominal pain, unexplained fatigue, dark urine, or pale stools
    • Performed during routine health examinations, pre-operative assessments, and evaluation of alcohol or drug-related liver injury
    • All tests work synergistically: enzyme elevations suggest hepatocellular injury or cholestasis; protein ratios indicate synthetic dysfunction; bilirubin patterns differentiate conjugation problems from hemolysis or obstruction
  • Normal Range
    • Albumin: 3.5-5.0 g/dL (35-50 g/L) - comprises approximately 50-60% of total serum proteins and represents hepatic synthetic capacity
    • Alkaline Phosphatase: 30-120 U/L (adults) - may vary with age and sex; higher in children and young adults due to bone growth
    • Bilirubin Direct (Conjugated): 0.1-0.3 mg/dL (1.7-5.1 μmol/L) - represents water-soluble bilirubin excreted by hepatocytes
    • Bilirubin Indirect (Unconjugated): 0.1-0.8 mg/dL (1.7-13.7 μmol/L) - unconjugated bilirubin bound to albumin
    • Bilirubin Total: 0.2-1.2 mg/dL (3.4-20.5 μmol/L) - sum of direct and indirect bilirubin; normal range ensures adequate hepatic processing
    • AST (SGOT): 10-40 U/L (0.17-0.67 μkat/L) - aspartate aminotransferase found primarily in liver, heart, and skeletal muscle
    • ALT (SGPT): 7-56 U/L (0.12-0.94 μkat/L) - alanine aminotransferase more liver-specific than AST; predominantly hepatic origin
    • Total Protein: 6.0-8.3 g/dL (60-83 g/L) - reflects combined albumin and globulin levels; indicator of overall nutritional and immune status
    • A/G Ratio (Albumin/Globulin): 1.0-2.5 - indicates balance between serum proteins; useful in assessing liver synthetic function and immune disorders
    • Gamma GT (GGT): 9-48 U/L (females may be slightly lower, 0-30 U/L) - highly sensitive for hepatobiliary disease; indicates cholestasis or enzyme induction
    • Globulin: 2.3-3.5 g/dL (23-35 g/L) - calculated from total protein minus albumin; represents immunoglobulins and other transport proteins
  • Interpretation
    • Albumin - Low levels (<3.5 g/dL) suggest severe liver disease, malnutrition, or malabsorption; takes weeks to normalize due to long half-life (20 days); critically low levels indicate advanced liver dysfunction or severe protein loss
    • Alkaline Phosphatase - Elevated (>120 U/L) indicates cholestasis, bone disease, or rapid bone growth; >4x normal suggests biliary obstruction; mild elevations may be physiologic or medication-related
    • Bilirubin Direct - Elevated (>0.3 mg/dL) indicates cholestasis or biliary obstruction; conjugated hyperbilirubinemia suggests hepatocellular dysfunction or bile duct obstruction; causes jaundice when >2-3 mg/dL
    • Bilirubin Indirect - Elevated (>0.8 mg/dL) suggests hemolysis, Gilbert's syndrome, or impaired hepatic uptake; unconjugated hyperbilirubinemia without elevated direct bilirubin indicates pre-hepatic or early hepatic disease
    • Bilirubin Total - Levels >1.2 mg/dL indicate hyperbilirubinemia requiring investigation; >2.0 mg/dL commonly causes clinical jaundice; pattern with direct/indirect fractionation helps determine etiology
    • AST - Elevated (>40 U/L) indicates hepatocellular injury but also found in cardiac and skeletal muscle damage; very high levels (>1000 U/L) suggest acute viral hepatitis or ischemic injury; AST/ALT ratio >2 suggests alcoholic liver disease
    • ALT - More specific for liver injury than AST; elevated (>56 U/L) indicates hepatocellular damage; ALT >AST pattern suggests non-alcoholic or viral hepatitis; values >1000 U/L suggest acute hepatitis or severe toxic injury
    • Total Protein - Low levels (<6.0 g/dL) suggest liver disease, malnutrition, kidney disease, or malabsorption; high levels (>8.3 g/dL) indicate dehydration or chronic inflammation; used with albumin to calculate globulin
    • A/G Ratio - Ratio <1.0 indicates elevated globulins relative to albumin, suggesting chronic liver disease, autoimmune hepatitis, or cirrhosis; low ratio often correlates with disease severity
    • Gamma GT - Elevated (>48 U/L) most sensitive for cholestasis; rises with alcohol consumption, medications (phenytoin, corticosteroids), or biliary disease; used to confirm hepatic origin of alkaline phosphatase elevation
    • Globulin - Elevated (>3.5 g/dL) may indicate chronic liver disease, multiple myeloma, or autoimmune conditions; low levels (<2.3 g/dL) suggest immunosuppression or protein loss; polyclonal increase common in cirrhosis
    • Pattern Recognition: ALT/AST elevation with normal bilirubin suggests hepatitis; elevated ALP/GGT with normal transaminases suggests cholestasis; all elevated markers indicate severe hepatocellular injury
    • Factors affecting results: hemolysis falsely elevates ALT/AST; lipemia interferes with albumin measurement; pregnancy slightly elevates ALP; alcohol consumption elevates GGT; Gilbert's syndrome causes mild unconjugated hyperbilirubinemia
  • Associated Organs
    • Albumin - Primary: Liver (synthesized by hepatocytes); Secondary: reflects nutritional status affecting all organ systems; low albumin indicates hepatic synthetic failure and predicts poor prognosis in cirrhosis
    • Alkaline Phosphatase - Primary: Liver and bone; Secondary: placenta, intestine, kidney; cholestatic liver disease, biliary cirrhosis, primary biliary cholangitis, and biliary obstruction cause marked elevation
    • Bilirubin Direct - Primary: Liver (hepatocyte conjugation and biliary excretion); Secondary: biliary system; indicates hepatocellular dysfunction or cholestasis; associated with complications including bile acid encephalopathy and pruritus
    • Bilirubin Indirect - Primary: Hemolytic system and liver; Secondary: bone marrow; elevation suggests hemolysis, ineffective erythropoiesis, or hepatic uptake dysfunction; Gilbert's syndrome most common benign cause
    • Bilirubin Total - Integrated measure of hepatic and hemolytic function; elevated levels affect central nervous system (kernicterus in neonates), skin pigmentation, and metabolism of lipophilic substances
    • AST - Primary: Liver, cardiac muscle, skeletal muscle; Secondary: red blood cells, kidneys; liver disease, myocardial infarction, muscular dystrophy, and hemolysis cause elevation; AST/ALT ratio indicates disease pattern
    • ALT - Primary: Liver (most specific); found predominantly in hepatocytes; Secondary: skeletal muscle in small amounts; acute and chronic hepatitis, fatty liver disease, and drug-induced liver injury cause elevation
    • Total Protein - Primary: Liver (albumin production); Secondary: bone marrow (immunoglobulin production); reflects nutritional status and immune system function; low levels in advanced liver disease predict poor outcomes
    • A/G Ratio - Primary: Liver and immune system balance; altered ratios indicate liver synthetic dysfunction or chronic immune activation; used in assessing cirrhosis severity and prognosis
    • Gamma GT - Primary: Liver and biliary system; Secondary: kidneys and pancreas; extremely sensitive for hepatobiliary disease; elevation correlates with cholestasis, alcohol abuse, and enzyme-inducing medications
    • Globulin - Primary: Bone marrow (B cells) and liver; represents immune system antibodies and acute phase reactants; elevated in chronic hepatitis, cirrhosis, and autoimmune liver disease
    • Associated Complications: Portal hypertension (varices, ascites), hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and coagulopathy in advanced liver disease
  • Follow-up Tests
    • Elevated ALT/AST: Order hepatitis serologies (HAV, HBV, HCV), complete blood count (CBC), platelet count, prothrombin time (PT/INR), and liver imaging (ultrasound or CT)
    • Elevated bilirubin: Perform abdominal ultrasound to assess for biliary dilation; order direct visualization of bile ducts if obstruction suspected; evaluate for hemolysis with reticulocyte count and haptoglobin
    • Elevated Alkaline Phosphatase/GGT: Order liver ultrasound to assess for cholestasis; perform 5'-nucleotidase or heat-stable alkaline phosphatase to confirm hepatic origin; assess for bone disease with alkaline phosphatase isoenzymes
    • Low albumin: Perform prothrombin time and platelet count to assess synthetic function; assess nutritional status with prealbumin; consider liver imaging for cirrhosis evaluation
    • Abnormal A/G ratio: Pursue serum and urine protein electrophoresis to evaluate for monoclonal proteins or autoimmune conditions affecting globulins
    • Suspected cirrhosis: Order FIB-4 index calculation; perform liver elastography (Fibroscan) for non-invasive fibrosis staging; consider liver biopsy if diagnosis unclear
    • Viral hepatitis workup: HAV IgM (acute), HBsAg/anti-HBc (HBV), HCV antibody and RNA testing; hepatitis D serology if HBsAg positive
    • Autoimmune hepatitis suspicion: Order antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-liver kidney microsomal antibody (anti-LKM)
    • Drug-induced liver injury: Discontinue suspected hepatotoxic medication; obtain repeat LFTs; consider anti-acetaminophen level if overdose suspected
    • Monitoring frequency: Repeat LFTs every 3-6 months for stable chronic liver disease; monthly during acute illness or medication adjustment; more frequently if considering treatment initiation
    • Iron metabolism tests: Ferritin, iron saturation for hemochromatosis; copper studies for Wilson's disease evaluation
    • Imaging studies: Ultrasound as first-line; CT or MRI for detailed assessment; Doppler ultrasound to assess portal flow; hepatobiliary scintigraphy for function assessment
    • Coagulation studies: PT/INR, activated partial thromboplastin time (aPTT), fibrinogen for assessment of hepatic synthetic function and bleeding risk
  • Fasting Required?
    • Fasting is NOT strictly required for the Liver Profile; however, fasting for 8-12 hours is recommended for optimal accuracy
    • When fasting is advised: Fasting minimizes lipemia that can interfere with protein measurements and bilirubin quantification; especially important in patients with known hyperlipidemia
    • Medications to address: Continue all regular medications unless specifically instructed otherwise by physician; avoid excessive alcohol for 24 hours before testing as it elevates GGT and transaminases
    • Acetaminophen usage: Avoid excessive acetaminophen intake for 3 days prior to testing; report chronic acetaminophen use to physician as it may falsely elevate liver enzymes
    • Dietary restrictions: No extreme fasting (>16 hours) as it may raise transaminase levels; maintain normal hydration status; avoid high-fat meals if fasting window exceeds 4 hours
    • Herbal supplements: Avoid herbal supplements (milk thistle, kava, echinacea) for 7 days before testing as they may affect liver enzyme levels and bilirubin
    • Strenuous exercise: Avoid intense exercise for 24 hours before testing; exercise elevates AST, ALT, and can affect protein levels
    • Timing considerations: Morning collection (8-10 AM) preferred for consistency; test on the same day of week and time for longitudinal comparisons in monitoring chronic disease
    • Cyclical variations: Some markers show diurnal and circadian variations; GGT and ALP may vary throughout the day; this is minimized by consistent collection timing
    • Menstrual considerations: Women may have slightly different baseline albumin and protein levels; test timing should be consistent relative to menstrual cycle for monitoring
    • Special populations: Pregnant women have naturally elevated ALP; elderly patients may have slightly lower albumin; children have higher ALP due to bone growth

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