What laboratory tests should be ordered for liver disease follow-up?

Laboratory Tests for Liver Disease Follow-up

For liver disease follow-up, laboratory testing should include bilirubin, albumin, ALT, ALP, GGT, and a full blood count, along with specific tests based on the underlying liver condition. 1

Core Laboratory Panel for Liver Disease Follow-up

Standard Panel (Every 6 months)

• Liver Function Tests:
  • Bilirubin (total and direct)
  • Albumin
  • ALT (alanine aminotransferase)
  • ALP (alkaline phosphatase)
  • GGT (gamma-glutamyltransferase)
• Complete Blood Count (CBC)
• Coagulation Studies:
  • Prothrombin time (PT)/International Normalized Ratio (INR)

Additional Tests Based on Specific Liver Conditions

For Viral Hepatitis

• Hepatitis viral load (HBV DNA or HCV RNA)
• Alpha-fetoprotein (AFP) for hepatocellular carcinoma screening

For Autoimmune Liver Disease

• Immunoglobulin levels (IgG, IgM, IgA)
• Autoantibodies (ANA, ASMA, AMA, LKM)

For Metabolic Liver Disease

• Ferritin and transferrin saturation (hemochromatosis)
• Alpha-1-antitrypsin level
• Ceruloplasmin (Wilson's disease)

For Non-alcoholic Fatty Liver Disease (NAFLD)

• Fasting glucose
• Lipid profile
• HbA1c

Frequency of Testing

The frequency of laboratory testing should be adjusted based on:

1. Disease Severity:

   • Stable chronic liver disease: Every 6 months 1, 2
   • Advanced fibrosis/cirrhosis: Every 3 months
   • Acute liver injury: Initially every 1-3 days until improving, then weekly until stable 2

2. Treatment Monitoring:

   • Patients on hepatotoxic medications: Every 3 months
   • Patients undergoing specific therapy (e.g., antivirals): As per treatment protocol

3. Disease-Specific Considerations:

   • MDR3 deficiency: Laboratory analysis every 6 months 1
   • NAFLD in children: Every 6 months initially, then based on response 1

Non-Laboratory Assessments to Include

• Fibrosis Assessment: Non-invasive fibrosis markers (FIB-4, NAFLD Fibrosis Score) or elastography should be performed at least annually 1
• Imaging: Liver ultrasound and/or MRI with MRCP at least annually 1

Special Considerations

For Children

• Include anti-liver kidney microsomal antibody and celiac antibodies in autoimmune panels
• Alpha-1-antitrypsin level and ceruloplasmin (for children >3 years) 1
• More frequent monitoring may be needed during growth spurts or puberty 1

For Pregnant Women with History of Liver Disease

• Follow-up clinical visit with laboratory analysis 6-8 weeks after delivery
• Second follow-up after 2-3 years due to increased risk of hepatobiliary and immune-mediated diseases 1

Common Pitfalls to Avoid

1. Ignoring mild elevations: Even mild elevations can indicate significant liver disease 2
2. Attributing all abnormalities to medications: Always exclude other causes 2
3. Focusing only on ALT/AST: Remember that normal aminotransferases do not exclude significant fibrosis or cirrhosis 1
4. Overlooking non-hepatic causes: Consider muscle or cardiac injury for AST elevations 2
5. Delaying referral: Patients with signs of liver failure or persistent unexplained elevations should be promptly referred to a hepatologist 2

By following this structured approach to laboratory testing for liver disease follow-up, clinicians can effectively monitor disease progression, treatment response, and detect complications early.