Alanine Transaminase (ALT)

Alanine Transaminase (ALT), also known as serum glutamate-pyruvate transaminase (SGPT), is an enzyme primarily found in the liver. The ALT test measures the level of this enzyme in the blood and is used to evaluate liver health and detect liver damage or disease.

1. What Is ALT?

• ALT is an enzyme that helps convert alanine (an amino acid) into energy for liver cells.

• It is found mainly in the liver, with smaller amounts in the kidneys, heart, and muscles.

• When liver cells are damaged, ALT leaks into the bloodstream, making it a useful marker for liver injury.

2. Why Is the ALT Test Performed?

The ALT test is used to:

• Detect liver damage from conditions like hepatitis, fatty liver disease, or alcohol abuse.

• Monitor the effects of medications or treatments that may harm the liver.

• Evaluate unexplained symptoms such as jaundice, fatigue, or abdominal pain.

• Track liver function in people with chronic liver disease.

3. ALT Reference Ranges

• Normal range: 7 – 56 units per liter (U/L)

• Slight variations may exist depending on the lab and patient characteristics.

4. How to Interpret ALT Results

🔹 Mildly Elevated ALT:

• May be caused by fatty liver disease, alcohol use, or certain medications (e.g., statins, acetaminophen).

🔹 Moderately to Severely Elevated ALT:

• Suggests more significant liver injury, often from viral hepatitis, toxins, or liver inflammation.

• ALT levels greater than 10x normal often indicate acute hepatitis or liver damage.

5. What Can Affect ALT Levels?

• Viral infections (e.g., hepatitis A, B, C)

• Alcohol consumption

• Non-alcoholic fatty liver disease (NAFLD)

• Autoimmune liver diseases

• Medications or supplements toxic to the liver

• Strenuous exercise (can temporarily raise ALT)

6. How to Maintain Healthy ALT Levels

• Maintain a healthy weight and follow a balanced diet

• Avoid excessive alcohol consumption

• Use medications only as directed and avoid unnecessary over-the-counter drugs

• Get vaccinated for hepatitis A and B if at risk

• Exercise regularly and manage underlying conditions like diabetes or high cholesterol

7. When to See a Doctor

🚨 Contact your healthcare provider if you:

• Have ALT levels above the normal range

• Experience symptoms of liver disease such as jaundice, dark urine, or upper right abdominal pain

• Are taking medications known to affect the liver

🔹 Key Takeaways

✅ ALT is a liver enzyme used to detect liver inflammation or damage.

✅ Elevated ALT levels may indicate liver disease, infections, or medication effects.

✅ Managing risk factors and lifestyle can help maintain normal ALT levels and liver health.

Albumin (ALB)

Albumin is a protein produced by the liver that plays an essential role in maintaining oncotic pressure (fluid balance) in the blood and transporting hormones, vitamins, and medications throughout the body. The Albumin test measures the concentration of albumin in the blood and is commonly used to evaluate liver function, kidney health, and nutritional status.

1. What Is the Albumin Test?

• Albumin is the most abundant protein in the blood plasma.

• It helps keep fluid from leaking out of blood vessels and transports various substances such as hormones and drugs.

• Low albumin levels may indicate liver disease, kidney disease, inflammation, or malnutrition.

2. Why Is the Albumin Test Performed?

This test is performed to:

• Assess liver and kidney function.

• Evaluate nutritional status, especially in hospitalized or chronically ill patients.

• Help diagnose and monitor chronic conditions like liver cirrhosis, nephrotic syndrome, or malabsorption disorders.

3. Albumin Reference Ranges

• Normal Range: 3.5 – 5.0 g/dL (may vary slightly by lab).

• Low albumin levels (< 3.5 g/dL) may indicate:

  - Liver disease (e.g., hepatitis, cirrhosis)

  - Kidney disease (e.g., nephrotic syndrome)

  - Inflammatory conditions or chronic illness

  - Malnutrition or malabsorption

• High albumin levels are rare and typically due to dehydration.

4. How to Interpret Albumin Results

🔹 Normal Albumin: Suggests adequate liver function and nutritional status.

🔹 Low Albumin: May reflect liver or kidney dysfunction, inflammation, or poor nutritional intake.

🔹 High Albumin: Often indicates dehydration rather than a disease state.

5. What Can Affect Albumin Levels?

Factors that can influence albumin levels include:

• Liver disease (impaired albumin synthesis)

• Kidney disorders (albumin lost in urine)

• Acute and chronic inflammation

• Severe infections or burns

• Poor diet or malabsorption conditions

6. When to See a Doctor

🚨 You should consult your healthcare provider if:

• Your albumin level is consistently low.

• You have symptoms of liver or kidney disease (e.g., swelling, jaundice, fatigue).

• You are undergoing treatment for a chronic condition that affects nutrition or protein levels.

🔹 Key Takeaways

✅ Albumin is a key protein that reflects liver function, kidney health, and nutritional status.

✅ Low levels may signal chronic disease or protein loss; high levels are usually due to dehydration.

✅ Regular monitoring helps manage chronic conditions and detect complications early.

Alkaline Phosphatase (ALP)

The Alkaline Phosphatase (ALP) test measures the amount of ALP enzyme in the blood. ALP is primarily found in the liver, bones, kidneys, and digestive tract. Elevated or decreased ALP levels can help diagnose liver disease, bone disorders, or issues related to bile flow.

1. What Is Alkaline Phosphatase?

• ALP is an enzyme that helps break down proteins and plays a role in bone growth and liver function.

• It is most active in tissues with high cell turnover, such as the liver and bones.

• ALP levels vary with age, growth, and physiological changes such as pregnancy.

2. Why Is the ALP Test Performed?

This test is used to:

• Evaluate liver function and detect bile duct blockages.

• Diagnose bone disorders such as Paget’s disease or bone cancer.

• Monitor liver or bone disease progression or treatment response.

• Assess causes of unexplained abdominal pain or jaundice.

3. ALP Reference Ranges

• Normal range: 44 – 147 IU/L (international units per liter) in adults.

• Higher normal values may occur in children, adolescents, and pregnant individuals due to bone growth or placental ALP.

4. How to Interpret ALP Results

🔹 Elevated ALP:

• Liver-related causes: hepatitis, bile duct obstruction, cirrhosis, liver tumors.

• Bone-related causes: healing fractures, growth spurts in children, bone tumors, Paget’s disease.

• Other causes: hyperparathyroidism, certain cancers, or pregnancy (placental ALP).

🔹 Low ALP:

• May suggest malnutrition, hypothyroidism, zinc deficiency, or rare genetic disorders affecting ALP production.

5. What Can Affect ALP Levels?

• Age and sex (higher in children and during growth phases)

• Pregnancy (placental ALP increases levels)

• Medications (e.g., anti-seizure drugs, oral contraceptives)

• Liver or bone injury or disease

6. How to Manage Abnormal ALP Levels

• Identify and treat the underlying cause (e.g., liver disease, bone condition)

• Maintain a balanced diet with adequate vitamin D and zinc

• Monitor other liver and bone markers (e.g., ALT, AST, calcium, phosphate) for a comprehensive assessment

7. When to See a Doctor

🚨 Contact your healthcare provider if you:

• Have persistently abnormal ALP levels

• Experience symptoms like jaundice, bone pain, fatigue, or swelling

• Are being monitored for liver or bone disease

🔹 Key Takeaways

✅ ALP is an enzyme linked to liver and bone health.

✅ Elevated levels can indicate liver or bone disorders; low levels may suggest nutritional or genetic issues.

✅ Additional tests are often needed to determine the exact cause of abnormal ALP levels.

Ammonia, Plasma

The Ammonia (Plasma) test measures the level of ammonia in the blood. Ammonia is a waste product formed when the body breaks down protein. Normally, the liver converts ammonia into urea, which is excreted in urine. Elevated ammonia levels can indicate serious liver dysfunction or inherited metabolic disorders.

1. What Is Ammonia?

• Ammonia is a nitrogen-containing compound produced during protein metabolism.

• It is toxic in high amounts and is normally converted to urea by the liver for safe elimination.

• When the liver is not functioning properly, ammonia can accumulate in the bloodstream, potentially leading to confusion, lethargy, or coma.

2. Why Is the Ammonia Test Performed?

The test is ordered to:

• Diagnose or monitor hepatic encephalopathy (a brain disorder caused by liver failure).

• Evaluate unexplained changes in mental status or consciousness.

• Detect inherited urea cycle disorders in infants and children.

• Assess the severity of liver disease or cirrhosis.

3. Ammonia Reference Ranges

• Normal range (adults): 15 – 45 µg/dL (micrograms per deciliter)

• Reference ranges may vary slightly between laboratories and age groups.

4. How to Interpret Ammonia Results

🔹 Elevated Ammonia:

• May indicate liver failure, hepatic encephalopathy, or Reye's syndrome (in children).

• Can be caused by genetic urea cycle disorders that prevent the breakdown of ammonia.

🔹 Normal Ammonia:

• Suggests that ammonia metabolism is functioning normally, even in cases of mild liver disease.

5. What Can Affect Ammonia Levels?

• Liver diseases (cirrhosis, hepatitis, acute liver failure)

• Gastrointestinal bleeding

• Excessive protein intake or catabolism

• Certain medications (e.g., valproic acid)

• Genetic metabolic disorders (especially in newborns)

6. How to Prepare for the Test and Ensure Accuracy

• Fasting may be required—follow your provider's instructions.

• Avoid smoking or physical exertion before the test, as these may affect results.

• The blood sample must be processed quickly and kept on ice to avoid falsely elevated readings.

7. When to See a Doctor

🚨 Seek medical attention if you or a loved one experiences:

• Sudden confusion or disorientation

• Lethargy or difficulty staying awake

• Symptoms of liver failure or unexplained vomiting (especially in children)

🔹 Key Takeaways

✅ Ammonia is a toxic byproduct of protein metabolism, normally removed by the liver.

✅ Elevated levels suggest liver dysfunction or a metabolic disorder.

✅ Prompt testing and treatment are crucial for high ammonia levels, especially in altered mental status.

Amylase

The Amylase test measures the level of amylase enzyme in the blood or urine. Amylase is produced mainly by the pancreas and salivary glands, and it plays a key role in digesting carbohydrates. Elevated or decreased levels can indicate pancreatic disorders or other medical conditions.

1. What Is Amylase?

• Amylase is an enzyme responsible for breaking down starches into sugars during digestion.

• It is produced primarily in the pancreas and salivary glands.

• Abnormal levels may indicate issues with the pancreas, such as pancreatitis or a blockage.

2. Why Is the Amylase Test Performed?

The test is used to:

• Diagnose or monitor acute or chronic pancreatitis.

• Detect pancreatic duct obstructions or pancreatic cancer.

• Investigate abdominal pain or other digestive symptoms.

• Evaluate salivary gland disorders (e.g., mumps).

3. Amylase Reference Ranges

• Normal range (blood): 30 – 110 U/L (units per liter)

• Normal range (urine): 2 – 34 U/hour

• Reference ranges may vary depending on the laboratory and testing method.

4. How to Interpret Amylase Results

🔹 Elevated Amylase:

• Common in acute pancreatitis, usually rising within hours and returning to normal in a few days.

• May also be seen in pancreatic cancer, gallstones, gastrointestinal perforation, or mumps.

🔹 Decreased Amylase:

• May occur in chronic pancreatitis or severe pancreatic damage where enzyme production is impaired.

• Can also be seen in liver disease or cystic fibrosis.

5. What Can Affect Amylase Levels?

• Medications (e.g., diuretics, birth control pills, opiates)

• Alcohol consumption

• High triglycerides

• Recent abdominal surgery or trauma

6. How Is the Test Performed?

• Blood sample: Collected from a vein, usually no fasting required.

• Urine sample: Often collected over 24 hours to assess amylase clearance.

7. When to See a Doctor

🚨 Contact your healthcare provider if you experience:

• Sudden, severe abdominal pain

• Nausea and vomiting

• Fever or rapid pulse (possible signs of pancreatitis)

• Unexplained elevations in amylase levels

🔹 Key Takeaways

✅ Amylase is an enzyme that helps digest carbohydrates, produced mainly by the pancreas and salivary glands.

✅ Elevated amylase levels may suggest acute pancreatitis or other abdominal conditions.

✅ Low levels can occur with chronic pancreatic disease or liver disorders.

Anti-Mullerian Hormone (AMH)

The Anti-Mullerian Hormone (AMH) test measures the level of AMH in the blood. AMH is a hormone produced by cells in developing egg sacs (follicles) in the ovaries. It is a key indicator of a woman's ovarian reserve, or the remaining number of eggs. This test is commonly used in fertility evaluations and to assess reproductive lifespan.

1. What Is Anti-Mullerian Hormone?

• AMH is secreted by ovarian follicles during the early stages of egg development.

• The amount of AMH correlates with the number of antral (small developing) follicles and therefore with ovarian reserve.

• In men, AMH plays a role in the development of male reproductive organs but is not typically tested after infancy.

2. Why Is the AMH Test Performed?

This test is used to:

• Evaluate a woman's ovarian reserve (fertility potential).

• Predict the response to fertility treatments (e.g., IVF).

• Diagnose or monitor polycystic ovary syndrome (PCOS).

• Monitor ovarian function during or after chemotherapy.

• Help diagnose premature ovarian insufficiency or menopause.

3. AMH Reference Ranges

• Reference ranges may vary by lab and age, but generally:

  - High (> 4.0 ng/mL): May indicate PCOS or high ovarian reserve

  - Normal (1.0 – 4.0 ng/mL): Indicates good fertility potential

  - Low (< 1.0 ng/mL): May suggest reduced ovarian reserve

  - Very low (< 0.5 ng/mL): May indicate diminished fertility or perimenopause

4. How to Interpret AMH Results

🔹 High AMH:

• Can be a sign of polycystic ovary syndrome (PCOS)

• May predict a strong response to ovarian stimulation during IVF

🔹 Normal AMH:

• Suggests a healthy ovarian reserve

🔹 Low or Very Low AMH:

• Indicates diminished ovarian reserve

• May impact fertility or suggest approaching menopause

5. What Can Affect AMH Levels?

• Age (AMH declines with age and becomes undetectable after menopause)

• PCOS (typically elevates AMH)

• Smoking (may lower AMH levels)

• Ovarian surgery or chemotherapy (can significantly reduce AMH)

• Hormonal contraceptives (may slightly suppress AMH, but not permanently)

6. When to See a Doctor

🚨 Contact your healthcare provider if you:

• Are under 35 and trying to conceive without success for 12 months (or 6 months if over 35)

• Have irregular or absent menstrual periods

• Have a family history of early menopause or fertility issues

• Are considering egg freezing or IVF

🔹 Key Takeaways

✅ AMH is a key marker of ovarian reserve and fertility potential.

✅ High AMH may indicate PCOS; low AMH suggests diminished ovarian reserve.

✅ AMH levels are useful for fertility planning and monitoring ovarian function over time.

Apolipoprotein B (ApoB)

The Apolipoprotein B (ApoB) test measures the amount of ApoB protein in the blood. ApoB is the primary protein component of atherogenic lipoproteins, including LDL (low-density lipoprotein), VLDL (very-low-density lipoprotein), IDL (intermediate-density lipoprotein), and lipoprotein(a). Because each atherogenic particle contains one ApoB molecule, this test reflects the total number of particles that can contribute to plaque buildup in the arteries and cardiovascular risk.

1. What Is Apolipoprotein B?

• ApoB is a structural protein required for the formation of lipoproteins that carry cholesterol and triglycerides in the blood.

• It plays a critical role in lipid metabolism and is a direct marker of the number of atherogenic particles.

• Elevated ApoB levels are associated with increased risk of cardiovascular disease (CVD), even when LDL cholesterol appears normal.

2. Why Is the ApoB Test Performed?

The test is used to:

• Evaluate cardiovascular disease (CVD) risk more accurately than standard cholesterol tests.

• Monitor lipid-lowering therapy, especially in high-risk individuals.

• Assess patients with metabolic syndrome, diabetes, or a strong family history of heart disease.

• Guide treatment in individuals with discordant LDL and ApoB levels.

3. ApoB Reference Ranges

• Normal range: < 90 mg/dL (low risk)

• Borderline high: 90 – 99 mg/dL

• High: ≥ 100 mg/dL (associated with higher cardiovascular risk)

• Target for high-risk individuals: < 80 mg/dL or even < 65 mg/dL depending on clinical guidelines

4. How to Interpret ApoB Results

🔹 Low ApoB:

• Indicates a lower number of atherogenic particles and lower CVD risk.

🔹 Elevated ApoB:

• Suggests an increased number of atherogenic lipoproteins, even if total LDL cholesterol is not elevated.

• May require intensified lipid-lowering therapy.

5. What Can Affect ApoB Levels?

• Diet high in saturated fats and cholesterol

• Sedentary lifestyle and obesity

• Genetic lipid disorders (e.g., familial hypercholesterolemia)

• Insulin resistance, metabolic syndrome, or type 2 diabetes

• Inflammatory conditions or thyroid dysfunction

6. How to Lower ApoB and Cardiovascular Risk

• Follow a heart-healthy diet (rich in fiber, low in saturated fats)

• Engage in regular physical activity (150+ minutes/week)

• Maintain a healthy weight and manage blood sugar levels

• Take lipid-lowering medications if prescribed (e.g., statins, ezetimibe, PCSK9 inhibitors)

• Avoid smoking and limit alcohol intake

7. When to See a Doctor

🚨 Speak to your healthcare provider if you:

• Have a family history of heart disease or stroke

• Have elevated LDL or triglycerides

• Are living with diabetes, hypertension, or metabolic syndrome

• Want to assess your personal cardiovascular risk more precisely

🔹 Key Takeaways

✅ ApoB is a more accurate marker of atherogenic particle count than LDL-C alone.

✅ High ApoB levels are associated with increased cardiovascular risk.

✅ Lifestyle changes and medications can help reduce ApoB levels and protect heart health.

Aspartate Aminotransferase (AST)

Aspartate Aminotransferase (AST), also known as serum glutamic-oxaloacetic transaminase (SGOT), is an enzyme found in several organs, but primarily in the liver and heart. The AST test measures the level of this enzyme in the blood to help detect liver or muscle damage.

1. What Is AST?

• AST is an enzyme involved in amino acid metabolism, facilitating the transfer of amino groups between molecules.

• It is found in high concentrations in the liver, heart, muscles, kidneys, brain, and red blood cells.

• When cells in these organs are damaged, AST leaks into the bloodstream, making it a useful diagnostic marker.

2. Why Is the AST Test Performed?

The test is used to:

• Evaluate liver function and detect liver diseases (e.g., hepatitis, cirrhosis).

• Assess muscle injury or inflammation (e.g., rhabdomyolysis).

• Monitor the effects of medications or toxins on the liver.

• Help differentiate causes of jaundice and abdominal pain.

3. AST Reference Ranges

• Normal range: 10 – 40 U/L (units per liter) in adults.

• Reference values may vary slightly depending on the lab and individual characteristics.

4. How to Interpret AST Results

🔹 Elevated AST:

• Common in liver conditions such as hepatitis, alcoholic liver disease, or liver cancer.

• Can also result from muscle injury, heart attack, or strenuous exercise.

• AST is not liver-specific and is best interpreted alongside ALT and other liver enzymes.

🔹 Normal or low AST:

• Typically indicates no significant liver or muscle damage. Low values are rarely concerning.

5. What Can Affect AST Levels?

• Liver diseases (e.g., viral hepatitis, fatty liver, cirrhosis)

• Muscle damage (e.g., trauma, seizures, intense exercise)

• Myocardial infarction (heart attack)

• Medications (e.g., statins, acetaminophen, antibiotics)

• Alcohol consumption

6. How to Support Healthy AST Levels

• Limit alcohol intake and avoid liver-toxic substances

• Use medications as directed and avoid unnecessary drug use

• Maintain a healthy diet and exercise routine

• Manage chronic conditions such as hepatitis or high cholesterol

7. When to See a Doctor

🚨 Contact your healthcare provider if you:

• Have elevated AST on blood tests

• Experience fatigue, jaundice, nausea, or abdominal pain

• Are taking medications that can affect the liver or muscles

🔹 Key Takeaways

✅ AST is an enzyme that helps detect liver and muscle injury.

✅ Elevated AST can result from liver disease, heart damage, or muscle injury.

✅ AST is often tested with ALT to provide a clearer picture of liver health.

Bilirubin, Direct

The Bilirubin test measures the level of bilirubin in the blood. Bilirubin is a yellow pigment formed from the breakdown of red blood cells. This test is typically divided into total, direct (conjugated), and indirect (unconjugated) bilirubin. Elevated levels can indicate liver dysfunction, bile duct obstruction, or increased red blood cell breakdown.

1. What Is Bilirubin?

• Bilirubin is produced when hemoglobin in red blood cells breaks down.

• The liver processes bilirubin and excretes it through bile into the intestines.

• There are two main forms:

  - Indirect (unconjugated): Not yet processed by the liver.

  - Direct (conjugated): Processed by the liver and ready for excretion.

2. Why Is the Bilirubin Test Performed?

The test is used to:

• Evaluate liver function and detect liver diseases such as hepatitis or cirrhosis.

• Diagnose the cause of jaundice (yellowing of skin and eyes).

• Assess bile duct obstruction or gallbladder disease.

• Monitor newborns for neonatal jaundice.

3. Bilirubin Reference Ranges

• Total Bilirubin: 0.1 – 1.2 mg/dL

• Direct Bilirubin: 0.0 – 0.3 mg/dL

• Indirect Bilirubin: Calculated by subtracting direct from total bilirubin.

4. How to Interpret Bilirubin Results

🔹 Elevated Total Bilirubin:

• May indicate liver disease, bile duct obstruction, or hemolytic anemia.

🔹 Elevated Direct Bilirubin:

• Suggests liver dysfunction or bile duct blockage (e.g., gallstones, tumors).

🔹 Elevated Indirect Bilirubin:

• Often caused by increased red blood cell breakdown or impaired liver uptake (e.g., Gilbert syndrome, hemolysis).

5. What Can Affect Bilirubin Levels?

• Liver diseases (hepatitis, cirrhosis)

• Gallbladder or bile duct conditions (e.g., gallstones, cholestasis)

• Hemolytic anemia or transfusion reactions

• Genetic conditions (e.g., Gilbert syndrome, Crigler-Najjar syndrome)

• Certain medications or alcohol use

6. How to Prepare for the Test

• Fasting may be required for 4–8 hours before the test (follow your provider’s instructions).

• Avoid alcohol and certain medications that affect liver function prior to testing.

7. When to See a Doctor

🚨 Speak to your healthcare provider if you:

• Develop yellowing of the eyes or skin (jaundice)

• Experience dark urine, pale stools, or right upper abdominal pain

• Have a history of liver or gallbladder disease

🔹 Key Takeaways

✅ Bilirubin is a byproduct of red blood cell breakdown processed by the liver.

✅ The test helps assess liver and bile duct function and diagnose jaundice.

✅ Elevated bilirubin levels may suggest liver disease, bile obstruction, or increased hemolysis.