| Test |
Abnormality |
Interpretation or potential cause |
| First tier |
|
|
| Full blood count (FBC) |
Macrocytosis* |
Possibly due to excessive alcohol intake, particularly if GGT also raised |
| Thrombocytopenia* |
Portal hypertension (possible hypersplenism) which may also be associated with ultrasound findings of enlarged spleen, portal vein and ascites or varices. Also common in chronic liver disease. |
| HbA1c or fasting glucose |
Elevated (e.g. HbA1c > 41 mmol/mol
or fasting glucose > 5.5 mmol/L) |
Indicates glucose intolerance conditions, e.g. type 2 diabetes and pre-diabetes; MASLD is common in these patient groups |
| Lipid profile |
Abnormal |
Contributor to fatty liver diseases, i.e. alcohol-related liver disease or MASLD |
Iron studies,*
inc. ferritin and TSAT |
Elevated |
Possible haemochromatosis. Check hereditary haemochromatosis (HFE) genotype if repeat testing remains high in fasting† and otherwise well patients |
Hepatitis screening
(HBsAg and anti-HCVAb) |
Positive |
Suggests hepatitis B or C infection. HCV requires confirmation of infection by either detection of HCV RNA or HCV Antigen |
| AUDIT-C screening |
Positive
(score ≥ 3 in female or ≥ 4 in male) |
Suggests potential alcohol misuse; full AUDIT tool assessment should then be undertaken |
| Second tier |
|
|
| Abdominal/ liver ultrasound** |
Echogenic liver, mass or dilated ducts |
Can be used to detect fatty liver, malignancy or gall stones/obstruction |
| Testing for other causes of viral hepatitis, e.g. Hepatitis A, Epstein Barr virus, Cytomegalovirus |
Positive |
Suggests infection with corresponding virus; hepatitis A testing may be a first-tier investigation if the patient reports travel to a country where infection is prevalent or contact with local outbreak or MSM |
| Autoantibodies and Immunoglobulins |
Antimitochondrial antibody (AMA) positive, increased IgM in combination with cholestatic LFTs |
Diagnostic of primary biliary cirrhosis |
| Anti-smooth muscle antibody (SMA)/ anti-liver kidney microsomal (LKM)/anti-liver soluble antigen (SLA)/anti-nuclear antibody (ANA) positive, particularly with elevated IgG |
Probable autoimmune hepatitis |
| Coeliac serology screen |
Positive |
Suggestive of coeliac disease-related liver damage |
Other tests dictated by clinical context or family history of liver disease, such as:
- Checking alpha-1 antitrypsin levels in people with a family history of deficiency
- Serum/urine copper and caeruloplasmin testing in patients with a family history of Wilson’s disease
|
