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Liver function tests/hepatic panel

The information on this page was reviewed and approved by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on January 14, 2022.

Your doctor may order a blood sample to check the health of your liver. Through liver function tests, your blood is analyzed for an array of proteins, enzymes and other substances.

This group of tests is also known as:

  • Liver panel
  • Liver profile hepatic function panel
  • LFT

These tests can indicate liver problems, possibly caused by cancer or disease, but they can’t definitively diagnose cancer.

What the panel analyzes

Liver function tests examine several protein indicators, including:

Albumin: Low levels can result from liver disease such as cirrhosis (scarring of the liver), kidney or thyroid disease, or an infection. High levels may signal severe diarrhea or dehydration.

Total protein: As with albumin, low levels of total protein may indicate issues such as liver and kidney disease. High levels may suggest the presence of multiple myeloma (a blood cancer) or infections with viral hepatitis or human immunodeficiency virus (HIV).

Prothrombin time: PT measures how long your plasma (the liquid part of your blood) takes to clot. Your liver makes coagulation factors that aid clotting, so slow clotting time (a high PT) may be associated with liver disease or damage.

A liver panel tests blood levels of several enzymes, including:

ALP (alkaline phosphatase): Your liver, bones, kidneys and digestive system contain this enzyme, which also occurs in smaller amounts in the rest of your body. Elevated levels may indicate Hodgkin lymphoma, a bacterial infection or heart failure. A high ALP also may result from mononucleosis (viral infection), a blocked bile duct, bone disorders or liver disease, such as cirrhosis and hepatitis (inflammation of the liver). ALP levels may be higher in children and pregnant women. Some drugs, including birth control, can affect ALP levels.

ALT (alanine transaminase): This enzyme mainly occurs in your liver, and it flows into your blood when liver cells get damaged. ALT levels can reveal a liver problem before symptoms, such as jaundice (a yellowing of the skin and eyes), become noticeable. ALT used to be called SGPT (serum glutamic-pyruvic transaminase).

AST (aspartate aminotransferase): Level changes in AST, an enzyme in your liver and muscles, can help detect or follow liver problems. It’s also called SGOT or serum glutamic oxaloacetic transaminase test.

Gamma-glutamyl transferase: This enzyme is also found mostly in your liver, though it’s present throughout the body. Liver damage causes it to leak into your bloodstream, so high levels may mean you have liver disease or a bile duct injury. It’s also called GGT, gamma-glutamyl transpeptidase, gamma-GT, GGTP and GTP.

Lactate dehydrogenase: This enzyme is used throughout your body in energy production. High levels can indicate tissue damage, such as liver or kidney disease, injury to the heart or other muscles, pancreatitis, some infections and some cancers, including lymphoma and leukemia. It’s also known as LD, LDH or lactic acid dehydrogenase.

Bilirubin: A hepatic panel also measures levels of bilirubin, a waste product. This yellowish substance is part of bile, a digestive juice produced by the liver and stored in the gallbladder before being released into the small intestine. When your liver isn’t working well, bilirubin can build up in your blood and cause jaundice. High bilirubin levels may signal liver or gallbladder disease, bile blockage, or red blood cell production problems. However, it’s important to check with your doctor, because high levels can also be the result of taking certain medications or eating certain foods.

Your doctor may order other blood tests along with a liver panel to gather more information on your health. These may include a comprehensive metabolic panel, which looks at some of the same substances as the liver panel, but adds glucose, calcium, sodium, potassium, chloride, carbon dioxide and BUN (blood urea nitrogen).

Total protein measurement in a comprehensive metabolic panel often includes examining your A/G ratio, which compares amounts of the two main forms of protein in your blood, albumin and globulins. A high A/G ratio can indicate the existence of leukemia and some genetic disorders. A low A/G ratio can be a sign of liver or kidney disease or an autoimmune disease.

If you possess one or more risk factors for liver cancer, your doctor may recommend you undergo an alpha-fetoprotein tumor marker (AFP) test. It measures a substance produced by cancer cells or normal cells reacting to cancer; the test can signify cancer of the liver, testicles or ovaries. High AFP levels also can indicate hepatitis, cirrhosis or other liver disease.

Risk factors for liver cancer:

  • Long-term infection with hepatitis B or C. The latter is more common in the United States, and it often doesn’t cause symptoms for many years. Hepatitis B usually does initially cause symptoms, such as jaundice and feeling sick, but doesn’t always become a chronic infection for most people.
  • Cirrhosis
  • Non-alcoholic fatty liver disease
  • Long-term alcohol abuse
  • Obesity
  • Smoking
  • Type 2 diabetes
  • Hereditary hemochromatosis (metabolic disease)

What to expect

There’s no preparation for a liver panel, unless your doctor wants to expand the procedure to include a comprehensive metabolic panel, in which case you would need to avoid eating and drinking for eight to 12 hours before the test.

The sample may be taken by a phlebotomist, an expert in drawing blood. A small needle is inserted into a vein, usually in one of your arms. A thin plastic tube connects the needle to one or more vacuum test tubes. These are sent to a laboratory for processing.

Risks

You may feel discomfort when the phlebotomist inserts the needle into your vein, and you may develop a bruise at the needle site.

Benefits

A liver panel may indicate you have cancer before you experience symptoms. Liver cancer often doesn’t produce symptoms until it’s advanced beyond early stages. These tests can also be useful for monitoring how the cancer is responding to treatment, and if it may be progressing.

Results

A liver panel can only indicate that you may have cancer or another condition. Follow-up testing is usually required.

If test results suggest you have cancer, it could be in the liver or elsewhere in your body. It may be cancer that originated in the liver and bile system, called primary tumors, or spread from another location, called secondary tumors or metastases.

Secondary liver tumors occur more often than primary liver tumors. The most common type of cancer that spreads to the liver is colorectal cancer, followed by breast and pancreatic cancers.

In addition to primary and secondary liver tumors, a liver panel may suggest you have multiple myeloma, lymphoma or leukemia.

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