Correlation of Correlation of alpha-fetoprotein & alpha-fetoprotein &

LFTs in liver LFTs in liver diseasesdiseases

ByByZahoor AhmedZahoor Ahmed

B .S MLT 06 B .S MLT 06

Alpha FetoproteinAlpha Fetoprotein

A major fetal serum protein, resembles A major fetal serum protein, resembles albumin.albumin.

Oncofetal antigens.Oncofetal antigens.

Half-life:4~6 days.Half-life:4~6 days.

Structure of AFPStructure of AFP

Albumin like Glycoprotein of 590 amino Albumin like Glycoprotein of 590 amino acids.acids.

Linked by disulfide bridges.Linked by disulfide bridges.

Gene is located on the long arm of Gene is located on the long arm of chromosome 4. chromosome 4.

Sites of synthesisSites of synthesis

Embryonic Yolk Embryonic Yolk

Gastrointestinal tractGastrointestinal tract

Liver cellsLiver cells

Physiological role of AFP:Physiological role of AFP:

A general transportation role.A general transportation role.

Able to bind estrogen.Able to bind estrogen.

As an immunosuppressant to prevent a As an immunosuppressant to prevent a

maternal antibody response to paternally maternal antibody response to paternally derived fetal antigen .derived fetal antigen .

AFP has no normal function in Adults.AFP has no normal function in Adults.

AFP TESTINGAFP TESTING

Based on Electrochemiluminesce Based on Electrochemiluminesce immunoassay “immunoassay “ECLIAECLIA” principle” principle

Analyzer :Analyzer : Elecsys 2010Elecsys 2010

Normal Range: Normal Range: <5.8 IU/ml (adult)<5.8 IU/ml (adult)

Importance of AFP in lab diagnosis:Importance of AFP in lab diagnosis:

As a tumor markerAs a tumor marker

As a pregnancy screening testAs a pregnancy screening test

ELEVATED LEVELELEVATED LEVEL

Cancer in Cancer in testestestes, , ovariesovaries, , biliary (liver secretion) tractbiliary (liver secretion) tract,, stomachstomach, or , or pancreas pancreas

Cirrhosis of the liver Cirrhosis of the liver Liver cancer Liver cancer Malignant teratomaMalignant teratomaViral hepatitisViral hepatitis

LFT’SLFT’S

Liver function tests measure Liver function tests measure various chemicals in the blood various chemicals in the blood made by the liver.made by the liver.

An abnormal result indicates a An abnormal result indicates a

problem with the liver, and may problem with the liver, and may help to identify the cause. help to identify the cause.

Tests involved in LFT’sTests involved in LFT’s

Alkaline phosphatase Alkaline phosphatase

Alanine transaminase (ALT)Alanine transaminase (ALT)

Aspartate transaminase (AST) Aspartate transaminase (AST)

Gamma-glutamyl transpeptidase .Gamma-glutamyl transpeptidase .

BilirubinBilirubin

TESTTEST What is it ?What is it ? What it Tells What it Tells Us? Us?

Alkaline Alkaline phosphphosphatase atase

An enzyme An enzyme produced in the produced in the liver, bone, and liver, bone, and placenta that is placenta that is released into the released into the blood during blood during injury or during injury or during such normal such normal activities as activities as bone growth or bone growth or pregnancy .pregnancy .

Bile duct Bile duct obstruction,obstruction,

liver injury, liver injury,

and and

some some cancers .cancers .

Normal Range = 20 - 125 U/L

TESTTEST What is itWhat is it ?? What it Tells What it Tells Us?Us?

Alanine Alanine transamintransaminase (ALT) ase (ALT)

An enzyme An enzyme produced in produced in the liver the liver that is that is released released into the into the blood when blood when liver cells liver cells are injured.are injured.

Liver cell Liver cell injury (as in injury (as in hepatitis )hepatitis )

Normal Range = 0 - 48 U/L

TESTTEST What is itWhat is it ?? What it Tells What it Tells Us?Us?

Aspartate Aspartate transamintransaminase (AST) ase (AST)

An enzyme An enzyme released released into the into the blood when blood when the liver, the liver, heart, heart, muscle, or muscle, or brain is brain is injured. injured.

Injury to Injury to liver, heart, liver, heart, muscles,muscles,

or brain.or brain.

Normal Range = M = 50 U/L F = 35 U/L

TESTTEST What is it?What is it? What it Tells What it Tells Us?Us?

Gamma-Gamma-glutamyl glutamyl transpeptidtranspeptidasease

An enzyme An enzyme produced by produced by the liver, the liver, pancreas, pancreas, and kidneys and kidneys and released and released into the into the blood when blood when these organs these organs are injured .are injured .

Organ Organ damage, drug damage, drug toxicity, toxicity, alcohol abuse, alcohol abuse, disease of the disease of the pancreas .pancreas .

Normal Range M=< 32 U/L F= < 49 U/L

TESTTEST What is itWhat is it ?? What it Tells What it Tells Us?Us?

BilirubiBilirubin n

A component of A component of the digestive the digestive juice (bile) juice (bile) produced by the produced by the liver. liver.

Obstruction to Obstruction to bile outflow, bile outflow, liver damage, liver damage, excessive excessive breakdown of breakdown of red blood cells red blood cells (from which (from which bilirubin is bilirubin is made) .made) .

NORMAL RANGE:TOTAL BILI = < 1.0 Mg/dlDirect bili = < 0. 3 Mg/dl

LIVER DISEASESLIVER DISEASES

LIVER CARCINOMAS LIVER CARCINOMAS

HEPATITISHEPATITIS

LIVER CIRRHISISLIVER CIRRHISIS

CORRELETIONCORRELETION

LIVER CARCINOMASLIVER CARCINOMAS

Also called Hepatocellular Also called Hepatocellular carcinoma.carcinoma.

It begins in the hepatocytes .It begins in the hepatocytes .

AFPAFP ASTAST ALTALT ALPALP GGTGGT BILI:BILI:

NORMALNORMAL

HEPATITISHEPATITIS

Also called Viral hepatitis .Also called Viral hepatitis . Hepatitis is a swelling of the liver .Hepatitis is a swelling of the liver . It can lead to cirrhosis or cancer .It can lead to cirrhosis or cancer .

AFPAFP ASTAST ALTALT ALPALP GGTGGT BILI:BILI:

LIVER CIRRHISISLIVER CIRRHISIS

Also called Hepatic fibrosis .Also called Hepatic fibrosis . Cirrhosis is scarring of the liverCirrhosis is scarring of the liver . .

AFPAFP ASTAST ALTALT ALPALP GGTGGT BILI:BILI:

CONCLUSIONCONCLUSION

AFP Is helpful to diagnose certain AFP Is helpful to diagnose certain liver disorders.liver disorders.

Higher levels of LFT’s also Higher levels of LFT’s also indicates liver disorders.indicates liver disorders.

There is a good correlation of There is a good correlation of alpha fetoprotein & liver function alpha fetoprotein & liver function test.test.

In most cases higher levels of AFP In most cases higher levels of AFP indicates higher levels of LFT’s .indicates higher levels of LFT’s .