Typical Laboratory Abnormalities in Alcoholic Liver Disease (ALD)

Alcoholic liver disease (ALD) encompasses a spectrum of injury, ranging from simple steatosis to frank cirrhosis.

Typical Laboratory Abnormalities in ALD

Serum enzymes

• AST >>> ALT: Both usually <300 IU/L
• Alkaline phosphatase (ALP) and g-glutamyl transpeptidase (GGT): Both usually elevated to a variable degree

Metabolic alterations

• Hyperglycemia
• Hypertrygleridemia
• Hyperuricemia
• Electrolyte abnormalities: low potassium, magnesium and phosphorus

Tests of liver function

• Serum albumin, prothrombin time, and serum bilirubin usually normal until significant liver injury present

Hematological abnormalities

• Mild anemia common (usually macrocytic)
• Platelets (normal to markedly decreased)
• Elevated white blood cell count: Leukemoid reactions associated with alcoholic hepatitis

Abbreviations: AST, aspartate aminotransferase;  ALT, alanine aminotransferase

References:

1. O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010 Jan;105(1):14-32. [Medline]
2. McCullough AJ, O'Connor JF. Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology. Am J Gastroenterol. 1998 Nov;93(11):2022-36.[Medline]