Abnormal liver blood test

Normal Liver Function Test Ranges

  • ALT: 10-50 U/L
  • ALP: 30-130 U/L
  • GGT: 1-55 U/L
  • Total Bilirubin: <21 µmol/L
  • Albumin: 35-50 g/L
  • Total Protein: 60-80 g/L
  • Globulin: 20-35 g/L

When to Request an Abdominal Ultrasound

  • Raised ALP or GGT with normal ALT (suggestive of biliary cause)
  • Persistent abnormal LFTs for >3 months without clear cause
  • Hepatomegaly, jaundice, or right upper quadrant pain
  • Suspected NAFLD in high-risk groups (obesity, diabetes)
  • Abnormal synthetic function (low albumin, raised INR)

Ultrasound helps assess liver texture, fatty infiltration, bile ducts, and presence of masses.

What to Do If LFTs Are Abnormal

  • ALT > 50 U/L: Think hepatocellular injury → check viral hepatitis, alcohol use, BMI
  • ALP > 130 U/L: Consider cholestasis → check GGT, RUQ pain, imaging
  • Isolated bilirubin > 21 µmol/L: Likely Gilbert’s if all else normal
  • Low albumin or abnormal INR: Synthetic dysfunction → refer if persistent

Initial Tests to Order (If Abnormal)

  • CRP and FBC
  • Hepatitis A/B/C screen
  • Liver autoimmune screen (ANA, SMA, AMA)
  • Ferritin + TSAT (exclude iron overload)
  • Caeruloplasmin if <40 yrs (only requested in secondary care) and alpha-1 antitrypsin
  • Ultrasound liver if ongoing or cholestatic picture

Refer if Any of the Following Apply

  • LFTs remain abnormal after 3 months
  • ALT persistently >100 U/L
  • ALP or bilirubin persistently raised
  • Evidence of liver failure (low albumin, raised INR)
  • Positive autoantibodies or unexplained hepatomegaly
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