This document summarizes information about several common blood tests: - Albumin measures the protein made by the liver to transport molecules through the blood. Abnormal levels may indicate liver or kidney disease. - Bilirubin measures a pigment from broken down red blood cells. High levels cause jaundice and can indicate liver problems. - Creatinine measures kidney function by detecting the waste product cleared from the blood by the kidneys. High levels mean reduced kidney function. - ALT, AST, and ALP measure liver enzymes and are used to diagnose and monitor liver disease when abnormal.

1. Albumin - blood (serum)
Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the
clear liquid portion of the blood. Albumin helps move many small molecules through the blood,
including bilirubin, calcium, progesterone, and medications. It plays an important role in keeping the fluid
from the blood from leaking out into the tissues.
The test is called a venipuncture.
This test can help determine if a patient has liver disease or kidney disease, or if the body is not
absorbing enough protein.
The normal range is 3.8 - 5.1 grams per deciliter (g/dL).
Lower-than-normal levels of serum albumin may be a sign of:
 Kidney diseases
 Liver disease (for example, hepatitis, or cirrhosis that make cause ascites)
Decreased blood albumin levels may occur when your body does not get or absorb enough nutrients,
such as:
 After weight-loss surgery
 Crohn's disease
 Low-protein diets
 Sprue
 Whipple's disease
Increased blood albumin level may be due to:
 Dehydration
 High protein diet
 Having a tourniquet on for a long time when giving a blood sample
Other conditions under which the test may be performed:
 Burns (widespread)
 Wilson's disease

2. Bilirubin - blood
Bilirubin is a yellowish pigment found in bile, a fluid made by the liver.
This article discusses the laboratory test that is done to measure bilirubin in the blood.
A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after
these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from
the body in the stool.
Bilirubin may also be measured with a urine test.
The test is called a venipuncture.
Large amounts of bilirubin in the blood can lead to jaundice. Jaundice is a yellow color in the skin, mucus
membranes, or eyes.
Jaundice is the most common reason to check bilirubin levels.
 Most newborns have some jaundice. The doctor or nurse will often check the newborn's bilirubin
level.
 The test may also be done in older infants, children, and adults who develop jaundice.
Normal levels are:
 Direct (also called conjugated) bilirubin: 0 to 0.3 mg/dL
 Total bilirubin: 0.3 to 1.9 mg/dL
In newborns, bilirubin levels are higher for the first few days of life.
Jaundice can also occur when more red blood cells than normal are broken down. This can be caused
by:
 Erythroblastosis fetalis
 Hemolytic anemia
 Transfusion reaction
The following liver problems may also cause jaundice or high bilirubin levels:
 Cirrhosis (scarring of the liver)
 Hepatitis
 Liver disease
 Gilbert's disease

3. Creatinine blood
The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well
your kidneys work.
Creatinine can also be measured with a urine test.
A blood sample is needed.
Creatinine is a chemical waste product of creatine. Creatine is a chemical made by the body and is used
to supply energy mainly to muscles.
This test is done to see how well your kidneys work. Creatinine is removed from the body entirely by the
kidneys. If kidney function is not normal, creatinine level increases in your blood. This is because less
creatinine is released through your urine.
The creatinine level also varies according to a person's size and muscle mass.
A normal result is:
0.7 to 1.4 mg/dL for men
0.6 to 1.1 mg/dL for women.
Higher than normal level may be due to:
 Blocked urinary tract
 Kidney problems, such as kidney damage or failure, infection, or reduced blood flow
 Loss of body fluid (dehydration)
 Muscle problems, such as breakdown of muscle fibers (rhabdomyolysis)
 Problems during pregancy, such as seizures (eclampsia), or high blood pressure caused by
pregnancy (preeclampsia)
Lower than normal level may be due to:
 Conditions involving the muscles and the nerves that control them (myasthenia gravis)
 Muscle problems, such as late stage muscle loss (muscular dystrophy)

4. ALT
Alanine transaminase (ALT) is an enzyme found in the highest amounts in the liver. Injury to the liver
results in release of the substance into the blood.
The test is called a venipuncture.
This test is used to determine if a patient has liver damage.
The normal range is up to 40 international units per liter (IU/L).
Increased levels of ALT often means that liver disease is present. Liver disease is even more likely when
levels of other liver blood tests are also increased.
An increase in ALT levels may be due to:
 Cirrhosis (scarring of the liver)
 Death of liver tissue (liver necrosis)
 Hepatitis
 Hemochromatosis
 Lack of blood flow to the liver (liver ischemia)
 Liver tumor or cancer
 Medications that are toxic to the liver
 Mononucleosis ("mono")
 Pancreatitis (swollen and inflamed pancreas)

5. AST
AST (aspartate aminotransferase) is an enzyme found in high amounts in liver, heart, and muscle cells. It
is also found in lesser amounts in other tissues.
This test is mainly done along with other tests (such as ALT, ALP, and bilirubin) to diagnose and
monitor liver disease.
The normal range is:
up to 42 IU/L in men
up to 32 IU/L in women
An increase in AST levels may be due to:
 Cirrhosis (scarring of the liver)
 Death of liver tissue
 Heart attack
 Hemochromatosis
 Hepatitis
 Lack of blood flow to the liver (liver ischemia)
 Liver cancer or tumor
 Medicines that are toxic to the liver
 Mononucleosis ("mono")
 Muscle disease or trauma
 Pancreatitis (swollen and inflamed pancreas)
AST levels may also increase after:
 Burns (deep)
 Heart procedures
 Seizure
 Surgery

6. ALP - blood test
Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP
include the liver, bile ducts, and bone.
A related test is the ALP isoenzyme test.
Reasons the test may be done include:
 To diagnose liver or bone disease.
 To check, if treatments for those diseases are working.
 As part of a routine liver function test.
The normal range is 44 to 147 IU/L (international units per liter).
Higher-than-normal ALP levels
 Biliary obstruction
 Bone conditions
 Osteoblastic bone tumors, osteomalacia, a fracture that is healing
 Liver disease or hepatitis
 Eating a fatty meal if you have blood type O or B
 Hyperparathyroidism
 Leukemia
 Lymphoma
 Paget's disease
 Rickets
 Sarcoidosis
Lower-than-normal ALP levels
 Hypophosphatasia
 Malnutrition
 Protein deficiency
 Wilson's disease
by:Dr. Mohammed H. Al-nakhli