Share on twitterShare on facebook Share this page: Was this page helpful? Also known as: AFP; Total AFP; AFP-L3% Formal name: Alpha-fetoprotein, Total; Alpha-fetoprotein-L3 Percent Related tests: CEA; hCG; Tumor Markers; DCP Were you looking instead for AFP Maternal, ordered during pregnancy? At a Glance Test Sample The Test Common Questions Ask Us Related Pages The Test 1. How is it used? 2. When is it ordered? 3. What does the test result mean? 4. Is there anything else I should know? How is it used? AFP is used as a tumor marker to help detect and diagnose cancers of the liver, testes, and ovaries. Though the test is often ordered to monitor people with chronic liver diseases such as cirrhosis, chronic hepatitis B or hepatitis C because they have an increased lifetime risk of developing liver cancer, most current guidelines do not recommend this use. A doctor may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest and most treatable stages. If a person has been diagnosed with hepatocellular carcinoma or another form of AFP-producing cancer, an AFP test may be ordered periodically to help monitor the person's response to therapy and to monitor for cancer recurrence. An AFP-L3% is sometimes also ordered to compare the amount of the AFP variant called AFP-L3 to the total amount of AFP. The AFP-L3% test is not yet widely used in the U.S. but has gained wider acceptance in other countries such as Japan. The test is used to help evaluate the risk of developing hepatocellular carcinoma, especially in those with chronic liver disease, and also to evaluate response of hepatocellular carcinoma to treatment. ^ Back to top When is it ordered? A physician may order an AFP blood test when: It is suspected that someone has liver cancer or certain cancers of the testes or ovaries; cancer may be suspected when, for example, lumps are felt in the abdominal area during a physical exam or when imaging tests detect possible tumors. Someone who has been diagnosed with and treated for a cancer of the liver, testes, or ovaries is being monitored for the effectiveness of treatment Someone is being monitored for cancer recurrence An AFP-L3% is sometimes ordered to help evaluate the risk of hepatocellular carcinoma when a person has chronic liver disease or to test the effectiveness of treatment of of hepatocellular carcinoma or monitor for its recurrence. ^ Back to top What does the test result mean?
Increased AFP levels may indicate the presence of cancer, most commonly liver cancer, cancer of the ovary, or germ cell tumor of the testes. However, not every liver, ovarian, or testicular cancer will produce significant quantities of AFP. Elevated levels may sometimes be seen with other cancers such as stomach, colon, lung, breast, and lymphoma, although it is rarely ordered to evaluate these conditions. Other diseases such as cirrhosis and hepatitis can also cause increased levels. When AFP is used as a monitoring tool, decreasing levels indicate a response to treatment. If concentrations after cancer treatment do not significantly decrease, usually to normal or near normal levels, then some of the tumor tissue may still be present. If concentrations begin to increase, then it is likely that the cancer is recurring. However, since AFP can be increased in hepatitis or cirrhosis, AFP levels can sometimes be misleading. If AFP levels are not elevated prior to treatment, then the test will not generally be useful to monitor the effectiveness of treatment or to monitor for recurrence. When the AFP concentrations of people with chronic liver disease go from moderately elevated to greatly elevated, their risk of developing liver cancer increases. When total AFP and AFP-L3% are significantly elevated, then the affected person has an increased risk of having or developing hepatocellular carcinoma in the next year or two. However, both AFP and AFP-L3% concentrations can be elevated, and fluctuate, in people with chronic hepatitis and cirrhosis. In these cases, a sharp increase in AFP is more important than the actual numerical value of the test result. ^ Back to top Is there anything else I should know? Not every person with increased AFP and AFP-L3% test results has cancer or will develop liver cancer. The AFP and AFP-L3% tests are not diagnostic; they are indicators. They must be used in conjunction with information from a history and physical examination as well as imaging studies to look for the development of tumors. Although these tests can provide useful information, they are not as specific or sensitive as doctors would wish. AFP can temporarily increase whenever the liver is injured and regenerating, and moderate elevations can be seen with a variety of conditions. Because of this, AFP testing can give some false positives. In addition, not every cancer will produce AFP, so a person could still have cancer even when the AFP is normal. For these reasons, the AFP test should not be used to screen the general population for cancer. AFP is not only a tumor marker. Because AFP is produced by the fetus, levels are normally higher in pregnant women and in their newborns. For more information on AFP testing during pregnancy, see Triple or Quad Screen. Alpha-Fetoprotein Tumor Marker (Blood) Does this test have other names? AFP What is this test? This is a blood test to look for alpha-fetoprotein (AFP) in your blood. AFP is normally made by a fetus's liver and yolk sac. It's the main protein during the first three months of development. AFP greatly decreases by age 1 and should only be found in adults in very low levels. AFP is one of several tumor markers. Tumor markers are molecules in the blood that are higher when a person has certain cancers. AFP is found mainly in liver cancer and nonseminomatous germ cell tumors, which are rare. These are found in the pineal gland in the brain. Some people with cirrhosis or chronic active hepatitis also have higher blood levels of AFP. Why do I need this test? You may have this test if your health care provider suspects you have liver cancer, testicular cancer, or cancers of the brain, mediastinum, or blood. This test is also used to watch cancer treatment or see if cancer has come back after treatment. What other tests might I have along with this test? If your doctor suspects you have liver cancer, you may also have: Liver function tests, or LFTs. These tests look at the part of your liver that is not affected by cancer to see how well your liver is working. The tests look for levels of certain substances in your blood, such as bilirubin, albumin, ALP, AST, ALT, and GGT. Blood clotting tests. Your liver makes proteins that help your blood clot. You may have blood tests, such as prothrombin time, or PT, to find out how well your liver makes these proteins and to look at your risk of bleeding. Blood urea nitrogen, or BUN, and creatinine level tests. These show how well your kidneys are working. Complete blood count, or CBC. This test measures your red blood cells, white blood cells, and platelets, which help blood to clot. It also shows how well your bone marrow is working. Your marrow is where new blood cells are made. Electrolytes and blood chemistry tests. You may have your blood calcium and cholesterol levels checked because these can rise when you have liver cancer. Viral hepatitis tests. Hepatitis B and C are linked to liver cancer, so you may have tests for viral hepatitis. You may also have tests for other tumor markers in your blood, including: Human chorionic gonadotropin, or hCG Lactate dehydrogenase, or LDH Your doctor also is likely to order imaging tests such as ultrasound, CT scan, and MRI to check for different cancers. What do my test results mean? Many things may affect your lab test results. These include the method each lab uses to do the test. Even if your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your health care provider. AFP is measured in nanograms per milliliter (ng/mL). An AFP level of less than 10 ng/mL is normal for adults. An extremely high level of AFP in your blood greater than 500 ng/mL could be a sign of liver tumors. High levels of AFP may mean other cancers, including Hodgkin disease, lymphoma, and renal cell carcinoma (kidney cancer). Not all people with these cancers will have an elevated AFP. And elevated AFP levels also could be a sign of cirrhosis or chronic acute hepatitis. How is this test done? The test requires a blood sample, which is drawn through a needle from a vein in your arm. Does this test pose any risks? Taking a blood sample with a needle carries risks that include bleeding, infection, bruising, or feeling dizzy. When the needle pricks your arm, you may feel a slight stinging sensation or pain. Afterward, the site may be slightly sore. What might affect my test results? If you are pregnant, your serum AFP level may be higher than normal. If you have hepatitis or cirrhosis, your AFP level may also be elevated. If you had cancer and the treatment worked, your AFP levels should be normal. How do I get ready for this test? You don't need to prepare for this test.
Liver function tests From Wikipedia, the free encyclopedia "LFTs" redirects here. For other uses, see LFT. Liver function tests Intervention ICD-10-PCS K-70 to K-77 ICD-9-CM 570573 MeSH D008111 MedlinePlus 003436 Liver function tests (LFTs or LFs) are groups of clinical biochemistrylaboratory blood assays designed to give information about the state of a patient's liver. [1] The parameters measured include prothrombin time (PT/INR), aPTT, albumin, bilirubin (direct and indirect), and others. Liver transaminases (AST or SGOT and ALT or SGPT) are useful biomarkers of liver injury in a patient with some degree of intact liver function. [2][3][4] Most liver diseasescause only mild symptoms initially, but these diseases must be detected early. Hepatic (liver) involvement in some diseases can be of crucial importance. This testing is performed by a medical technologist on a patient's serum or plasma sample obtained by phlebotomy. Some tests are associated with functionality (e.g., albumin), some with cellular integrity (e.g., transaminase), and some with conditions linked to the biliary tract (gamma-glutamyl transferase and alkaline phosphatase). Several biochemical tests are useful in the evaluation and management of patients with hepatic dysfunction. These tests can be used to detect the presence of liver disease, distinguish among different types of liver disorders, gauge the extent of known liver damage, and follow the response to treatment. Some or all of these measurements are also carried out (usually about twice a year for routine cases) on those individuals taking certain medications anticonvulsants are a notable example to ensure the medications are not damaging the person's liver. Contents [hide] 1 Standard liver panel o 1.1 Albumin o 1.2 Aspartate transaminase o 1.3 Transaminases o 1.4 Alkaline phosphatase o 1.5 Total bilirubin o 1.6 Direct bilirubin o 1.7 Congenital bilirubin disorders o 1.8 High bilirubin in neonates o 1.9 Gamma glutamyl transpeptidase o 1.10 INR 2 Other tests commonly requested alongside LFTs o 2.1 5' Nucleotidase o 2.2 Coagulation test o 2.3 Serum glucose o 2.4 Lactate dehydrogenase 3 See also 4 References 5 External links Standard liver panel[edit]
This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2008) Although example reference ranges are given, these will vary depending on age, gender, ethnicity, method of analysis, and units of measurement. Individual results should always be interpreted using the reference range provided by the laboratory that performed the test. Albumin[edit] Albumin is a protein made specifically by the liver, and can be measured cheaply and easily. It is the main constituent of total protein (the remaining from globulins). Albumin levels are Reference range 3.5 to 5.3 g/dL decreased in chronic liver disease, such as cirrhosis. It is also decreased in nephrotic syndrome, where it is lost through the urine. The consequence of low albumin can be edema since the intravascular oncotic pressure becomes lower than the extravascular space. An alternative to albumin measurement is prealbumin, which is better at detecting acute changes (half-life of albumin and prealbumin is about 2 weeks and about 2 days, respectively). Aspartate transaminase[edit] AST, also called serum glutamic oxaloacetic transaminase or aspartate aminotransferase, is similar to ALT in that it is another enzyme associated with liver parenchymal cells. It is raised in acute liver damage, but is also present in red blood cells, and cardiac and skeletal muscle, so is not specific to the liver. Theratio of AST to ALT is sometimes useful in differentiating between causes of liver damage. [6][7] Elevated AST levels are not specific for liver damage, and AST has also been used as a cardiac marker. Transaminases[edit] Main article: Elevated transaminases AST/ALT elevations instead of ALP elevations favor liver cell necrosis as a mechanism over cholestasis. When AST and ALT are both over 1000 IU/L, the differential can include Reference range 6-40 IU/L [5]
acetaminophen toxicity, shock, or fulminant liver failure. When AST and ALT are greater than three times normal but not greater than 1000 IU/L, the differential can include alcohol toxicity, viral hepatitis, drug-induced level, liver cancer, sepsis, Wilson's disease, post-transplant rejection of liver, autoimmune hepatitis, and steatohepatitis (nonalcoholic). AST/ALT levels elevated minorly may be due to rhabdomyolysis, among many possibilities. Alkaline phosphatase[edit] Main article: Elevated alkaline phosphatase Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. ALP levels in plasma rise with large bile duct obstruction, intrahepatic cholestasis, or infiltrative diseases of the liver. ALP is also present in bone and placental tissue, so it is higher in growing children (as their bones are being remodelled) and elderly patients with Paget's disease. In the third trimester of pregnancy, ALP is about two to three times higher. Total bilirubin[edit] Measurement of total bilirubin includes both unconjugated and conjugated bilirubin. Unconjugated bilirubin is a breakdown product of heme (a part of hemoglobin in red blood cells). It is Reference range 30 to 120 IU/L [8]
Reference range 0.11.0 mg/dL very hydrophobic and is mainly transported bound to albumin circulating in the blood. Addition of high-concentration hydrophobic drugs (certain antibiotics, diuretics) and high free fatty acids can cause elevated unconjugated bilirubin. Heme can also come from myoglobin, found mostly in muscle, cytochromes, found mostly in mitochondria, catalase, peroxidase, and nitric oxide synthase. The liver is responsible for clearing the blood of unconjugated bilirubin, and about 30% of it is taken up by a normal liver on each pass of the blood through the liver by the following mechanism: bilirubin is taken up into hepatocytes, 'conjugated' (modified to make it water-soluble) by UDP-glucuronyl-transferase, and secreted into the bile by CMOAT (MRP2), which is excreted into the intestine. In the intestine, conjugated bilirubin may be metabolized by colonic bacteria, eliminated, or reabsorbed. Metabolism of bilirubin intourobilinogen followed by reabsorption of urobilinogen accounts for the yellow color of urine, as urine contains a downstream product of urobilinogen. Further metabolism of urobilinogen into stercobilin while in the bowels accounts for the brown color of stool. Thus, having white or clay-colored stool is an indicator for a blockage in bilirubin processing and thus potential liver dysfunction or cholestasis. Increased total bilirubin (TBIL) causes jaundice, and can indicate a number of problems: 1. Prehepatic: Increased bilirubin production can be due to a number of causes, including hemolytic anemias and internal hemorrhage. 2. Hepatic: Problems with the liver are reflected as deficiencies in bilirubin metabolism (e.g., reduced hepatocyte uptake, impaired conjugation of bilirubin, and reduced hepatocyte secretion of bilirubin). Some examples would be cirrhosis and viral hepatitis. 3. Posthepatic: Obstruction of the bile ducts is reflected as deficiencies in bilirubin excretion. (Obstruction can be located either within the liver or in the bile duct). Direct bilirubin[edit] The diagnosis is narrowed down further by evaluating the levels of direct bilirubin. If direct (conjugated) bilirubin is normal, then the problem is an excess of unconjugated bilirubin (indirect bilirubin), and the location of the problem is upstream of bilirubin conjugation in the liver. Hemolysis, or internal hemorrhage can be suspected. If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it. Bile Reference range 0.10.4 mg/dL ductobstruction by gallstones, hepatitis, cirrhosis or cancer should be suspected. Congenital bilirubin disorders[edit] About 5% of the population has Gilbert's syndrome, a mutation (or variation) in the UDP-glucuronyl-transferase promotorthat manifests itself as jaundice when the individual is stressed (i.e. starves). Autosomal recessive knockouts of UDP-glucuronyl-transferase can lead to Crigler-Najjar syndrome and elevations of unconjugated bilirubin. Defects in CMOAT (MRP2) results in Dubin-Johnson syndrome and elevations of conjugated bilirubin. High bilirubin in neonates[edit] Neonates are especially vulnerable to high bilirubin levels due to an immature blood-brain barrier that predisposes them to kernicterus/bilirubin encephalopathy, which can result in permanent neurological damage. Neonates also have a low amount of functional UDP-glucuronyl-transferase and can have elevated unconjugated bilirubin, since conjugation is limited. So, newborns are often treated with UV light to turn the hydrophobic, albumin-binding unconjugated bilirubin into a form that is more hydrophilic and able to be secreted in urine, sparing the neonate's brain. Gamma glutamyl transpeptidase[edit] Reference range Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP,gamma glutamyl transpeptidase (GGT) may be elevated with even minor, subclinical levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated elevation in ALP (GGT is raised in chronic alcohol toxicity). INR[edit] Prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. This test is also called "ProTime INR" and "INR PT". They are used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. Other tests commonly requested alongside LFTs[edit] 5' Nucleotidase[edit] 5' Nucleotidase (5'NTD) is another test specific for cholestasis or damage to the intra- or extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for ascertaining whether an elevated ALP is of biliary or extrabiliary origin. Coagulation test[edit] 0 to 42 IU/L [8]
The liver is responsible for the production of coagulation factors. INR measures the speed of a particular pathway of coagulation, comparing it to normal. Increased levels of INR means blood is taking more time than usual to clot. The INR increases only if the liver is so damaged that synthesis of vitamin K-dependent coagulation factors has been impaired; it is not a sensitive measure of liver function. It is very important to normalize the INR before operating on people with liver problems (usually by transfusion with blood plasma containing the deficient factors), as they could bleed excessively. Serum glucose[edit] The serum glucose test, abbreviated as "BG" or "Glu", measures the liver's ability to produce glucose (gluconeogenesis); it is usually the last function to be lost in the setting of fulminant liver failure. Lactate dehydrogenase[edit] Lactate dehydrogenase (LDH) is found in many body tissues, including the liver. Elevated levels of LDH may indicate liver damage. [citation needed] LDH isotype-3 (or cardiac) is used for estimating damage to cardiac tissue, although troponin and creatine kinase tests are more preferred. [9]
See also[edit] Reference ranges for blood tests Elevated transaminases Liver disorders Child-Pugh score References[edit] 1. Jump up^ Lee, Mary (2009-03-10). Basic Skills in Interpreting Laboratory Data. ASHP. pp. 259. ISBN 978-1-58528-180-0. Retrieved 5 August 2011. 2. Jump up^ Johnston DE (1999). "Special considerations in interpreting liver function tests". Am Fam Physician 59 (8): 222330.PMID 10221307. 3. Jump up^ McClatchey, Kenneth D. (2002). Clinical laboratory medicine. Lippincott Williams & Wilkins. pp. 288. ISBN 978- 0-683-30751-1. Retrieved 5 August 2011. 4. Jump up^ Mengel, Mark B.; Schwiebert, L. Peter (2005). Family medicine: ambulatory care & prevention. McGraw-Hill Professional. pp. 268. ISBN 978-0-07-142322-9. Retrieved 5 August 2011. 5. Jump up^ "http://www.gpnotebook.co.uk/simplepage.cfm?ID=32224 0579" 6. Jump up^ Nyblom H, Berggren U, Balldin J, Olsson R (2004). "High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking". Alcohol Alcohol. 39 (4): 336339. doi:10.1093/alcalc/agh074. PMID 15208167. 7. Jump up^ Nyblom H, Bjrnsson E, Simrn M, Aldenborg F, Almer S, Olsson R (September 2006). "The AST/ALT ratio as an indicator of cirrhosis in patients with PBC". Liver Int. 26 (7): 840845. doi:10.1111/j.1478- 3231.2006.01304.x. PMID 16911467. 8. ^ Jump up to: a
b MedlinePlus Encyclopedia Liver function tests 9. Jump up^ Nageh T, Sherwood RA, Harris BM, Byrne JA, Thomas MR (2003). "Cardiac troponin T and I and creatine kinase-MB as markers of myocardial injury and predictors of outcome following percutaneous coronary intervention". International journal of cardiology 92 (23): 285 293. doi:10.1016/S0167-5273(03)00105-0. PMID 14659867. External links[edit]