Which lab tests may be performed in the diagnosis of acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Laboratory testing

  • Complete blood count: May reveal thrombocytopenia

  • Coagulation studies: PT and/or international normalized ratio (INR)

  • Liver function tests: Often elevated levels of aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT), alanine aminotransferase (ALT)/serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP)

  • Serum bilirubin level: Elevated

  • Serum ammonia level: May be dramatically elevated (accuracy: arterial > venous level)

  • Serum glucose level: May be dangerously low

  • Serum (arterial) lactate level: Often elevated

  • Arterial blood gas: May reveal hypoxemia

  • Serum creatinine level: May be elevated

  • Serum free copper and ceruloplasmin levels: Low levels in Wilson disease

  • Serum phosphate level: May be low

  • Acetaminophen and acetaminophen-protein adducts levels

  • Drug screening: Consider in patients who are intravenous drug abusers

  • Blood cultures: For patients with suspected infection

  • Viral serologies: Consider for hepatitis A virus immunoglobulin M (IgM), hepatitis B surface antigen (HBsAg), hepatitis B virus anticore IgM; hepatitis C viral load testing; hepatitis D virus IgM if HBsAg is positive; in posttransplantation or immunosuppressed setting, consider studies for cytomegalovirus viremia, cytomegalovirus antigenemia, and herpes simplex virus

  • Autoimmune markers (for autoimmune hepatitis diagnosis): Antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and immunoglobulin levels

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