Blood Test Accuracy

[JimmyJackson]

How reliable are blood tests in defining liver function ? I have doubts about their accuracy & would be interested in the experience of others.

[AyrshireK]

Why are you doubting your blood test results? Expecting them to be better or worse than they are?

As I understand it you have cirrhosis - in compensated cirrhotic patients you'll often find that the standard liver blood tests can return as near normal as the cirrhotic bits of your liver don't emit the things that are tested it's only the functioning parts of the liver that do or the struggling parts and those are the ones that would put liver bloods out of sync.

Bloods alone are never enough to give a diagnosis and it needs to be a jigsaw of tests to keep a check on liver - patients with cirrhosis should have a 6 monthly ultrasound scan and 6 monthly bloods.

The British Liver Trust has a page that goes into all the tests together with FAQ's etc.

britishlivertrust.org.uk/in...

Katie

[JimmyJackson in reply to AyrshireK]

Hi

I take account of your explanation, but do wonder therefore what use the blood test is in that it only shows up that parts of the liver are OK, not so far as I can ascertain how much is OK.

I have had ultra sound & recent CTC scan, which again seem not to cause any alarm. Having said all that a series of fibro scans some while ago showed a marked deterioration, this seems to have been ignored & no more fibro scans

In the real world, whatever is causing it I feel B awful most days mainly as I sleep badly.

I have never been a drinker, or had to my knowledge done/taken anything that might have caused my cirrhosis, this was only diagnosed during successful treatment bowel cancer some 5 years ago, I have also kept very fit all my life. So the cause remains unknown

I also suffer from GERD & was recently put on Omprazole

One of the strange effects of whatever is causing my severe problem is that I only seem to tolerate any drug that might help eg Omprazole, Mirtazapine, for short periods then get a bad reaction

I am not complaining about my treatment under the NHS which is the best, but still feel lousy & would love to know why.

[AyrshireK in reply to JimmyJackson]

My hubby has the same sleep problems and chronic fatigue, he has cirrhosis yet his bloods return as near normal every time they are taken which is very infrequently as his consultant appointments keep getting cancelled. Doctors will say to him "Oh, don't you look well!" when inside hubby feels like death warmed up.

There is no explanation of they symptoms in blood tests and we just get told it's "one of those things that goes along with cirrhosis".

He's never had CT scans only on transplant assessment and a follow up to his aneurysm surgery. Only has 6 monthly ultrasound and bloods, never a fibroscan as his consultant says it won't add anything to the diagnosis as we know he has cirrhosis.

Hospital bloods are more thorough than GP ones as they tend to do a full liver panel which looks into a lot more than GP ones.

At the moment all is on hold for us with covid lockdown so he's not had any follow up this year since January.

When you have cirrhosis it is now more about managing symptoms arising and many of these would be linked to abnormal bloods i.e. ascites goes along with lowered albumin levels, jaundice and itching with elevated bilirubin.

Katie

[Phil1983]

I'm confused by it my GP didn't even examine me he just wanted to see my blood test results. Even when my GGT was 250 he just ordered more blood tests.

I've had 4 LFTs and at least one FBC. Doctors are convinced I'm fine but I know I'm not.

[AyrshireK in reply to Phil1983]

If it is only GP bloods you've had done they shouldn't be relied up for a diagnosis, if you feel you definitely have something wrong it should be followed up, perhaps with a scan. Have you asked for peace of mind to have an ultrasound scan at least?

Katie

[Phil1983 in reply to AyrshireK]

Hi Katie

I've asked about a scan but they won't because of covid. The GP I was speaking with has left the practice so I'm speaking to another doctor over the phone next week.

I was told they weren't worried because my FBC was ok and my LFTs had improved so much since I stopped drinking. They would test me again in August. But there's too many worrying signs hopefully the doctor will be helpful otherwise I'll have to go private. I looked into it but they said they could do an MRI but there was no heptologist to speak to.

A big part of me wants to just ignore it as I know the result won't be good but the worse I feel the harder it is to ignore. When I'm feeling good I can just crack on but recently I've not been sleeping well and today I feel horrible.

[AyrshireK in reply to Phil1983]

If you are having symptoms despite decent bloods then say to them that you are aware in certain circumstances bloods might not reflect more advanced liver disease and that for peace of mind you would like a scan, you have to get that bit of back ground knowledge to know what you should push for.

It's your health and I know covid has messed things up but NHS must be getting a little back on track 'cos hubbies appointment for his 6 month ultrasound just arrived (it was due February but doctor had failed to order it so when it was eventually booked for April it never happened - now going next Friday).

Katie

[Hidden in reply to Phil1983]

Hi Phil, a lot of NHS trusts are starting to perform ultrasound scans again. Maybe you could discuss the waiting list times for one at your hopsital with your GP?

[Phil1983 in reply to Hidden]

Thanks for the advice

Hopefully the GP will be able to do something

[Hidden in reply to Phil1983]

Hi

I had bloods done which came back ok but I still felt rotten. I had s telephone consultation with my consultant , I said by Dr has asked me to ask you if there are other bloods he think I should have? He told me INR and AFP. He also booked me in for an ultrasound and gastroscopy. I had my scan this week, I'm waiting for my gastroscopy, he did put it as urgent because an a and e Dr had referred me for one in March but then we bad covid-19. My bloods came back with raised bile acids, I've been out on ursodeoxycholic tablets and bloods once per week. I do hope you get sorted. Take care and stay safe Lynne

[Coco513]

My consultant said that blood tests do not always show what is happening in the liver in the same way a biopsy can. I think, though, there would be some symptoms to warrant investigation.

[JimmyJackson]

I had biopsy but that also only relates to the part of the liver tested so again not 100%

[Kristian]

Unlike in kidney disease blood test wont give you an accurate percentage of how your liver is working. However they are useful indicators of active damage, inflammation and metabolic function. It's not necessarily the number that matters, although this does have some bearing, it's the trend over time that can have more influence. There are also some pretty fundamental ones that indicate how well your liver is carrying out the tasks it does to enable the body to function properly. Tests like INR and platelets, Albumin, Sodium, bilirubin, Red blood cells are all important indicators of disease progression and liver function. Its these that probably have more influence in decision making in advanced liver disease. However, ALT, ALP are still useful indicators of inflammation and damage that may be occurring or has recently occurred at the time of test. These can help indicate that whatever is causing the problem may still be active.

Other blood tests also include things like tumors markers that also need to be monitored in advanced active disease and also the function of other organs that may be affected by knock effects of liver disease or the meds taken to control it. Things like kidney function tests fall here.

Hope that's helpful. As Katie says, it's all about forming a big picture. Blood test play an important role in that and can give a reasonable proxy as to how you are doing at any given point in time.

[JimmyJackson in reply to Kristian]

Many thanks most helpful

[Carp01]

Hi Jimmy, I hope all is good. The best advice is to trust your GP they see thousands of tests and know what tin look out for. They also take into account history, prev tests. Prev health etc.

They won't assess based on just one blood test.

If you have liver damage they will present in blood tests and trends over time. That's a fact.

[lyn3]

Hi Jimmy, i hope your feeling some what better than you have been...

My hubbys bloods always comes back normal, and his drs will say your liver is ok. This i found strange considering hubbys now 52 and been drinking since he was 14, and up until recently he was drinking a ltr of vodka or whisky a day along with largers. (My nick name for him was robot),Hes ended up in hospital over the years with various things and yet each time his bloods for his liver came back normal. The last few months ,hes shown all signs of cirrhosis, swollen belly, (swollen legs and feet have got worse), sleeping alot, confusion even a simple thing like being able to check phone messages is a task,generally feels unwell all the time, exausted when just taking a few steps to the kitchen. I rang the drs with all my concerns and the dr admitted him to hospital, they checked him over, done bloods and he was home within 2 hours. I actually thought he was lieing when he said his bloods came back normal, they said his liver area and abdomine were fine. And he was free to go home, so i wrote to the drs concerning this and the dr confirmed the bloods came back normal but wanted to see hubby, he went in,the dr examined him and said that his liver is swollen and hard, and he wanted him to have intense blood tests and then a scan done. The dr is not sure why they said his liver area felt fine (it was on the notes from the hospital, and was within 2 weeks of being seen there) or why they didnt send him for a scan. The dr seems to think hubby does have cirrhosis but how far its gone he doesnt know , so hoping will know from the scan and bloods this time. I guess it all depends on the person, One of his friends blood test always came back stating his liver was bad from day one.

Hope this has helped. Ill let you know the results of the bloods he had done yesterday when they come through, will be interesting if they say they are normal.

Take care

Lyn..