Liver Health

Actin (Smooth Muscle) Antibodies (ASMA; anti-F-actin) are autoantibodies that target proteins in smooth muscle and are most strongly linked to autoimmune hepatitis (AIH), especially type 1, though they can also appear in chronic active hepatitis and, less commonly, in primary biliary cholangitis (PBC). Positivity is reported in about 52–85% of people with AIH or chronic active hepatitis and about 22% with PBC, and ASMA often occurs together with ANA and elevated IgG, forming a characteristic autoimmune profile. Doctors order this test mainly to help identify AIH when liver enzymes (ALT, AST) are high, rule out other causes of liver disease, and distinguish between AIH, PBC, and other conditions. A negative result (0–19) does not support AIH on its own, a weak positive (20–30) suggests possible autoimmune activity that needs to be interpreted alongside other blood tests, imaging, and symptoms, and a moderate-to-strong positive (>30) provides stronger support for AIH, though a full diagnostic assessment and sometimes a liver biopsy are required. While antibody levels can decline with treatment, changes in titers are not reliable for monitoring, so doctors primarily track liver enzymes, bilirubin, IgG, and symptoms. If positive, further testing may include antibody panels (ANA, AMA, anti-LKM-1, anti-SLA), viral hepatitis screening, imaging, and in some cases a biopsy; if AIH is confirmed, treatment often involves immunosuppressive medications (such as corticosteroids with or without azathioprine) to reduce inflammation and prevent fibrosis or cirrhosis.

Related to autoimmune hepatitis

the major protein component of serum

While alpha globulins and beta globulins are primarily transport proteins, gamma globulins are mainly comprised of immunoglobulins (Igs), also known as antibodies.

An aid in the evaluation of liver function

a group of molecules produced by the liver from cholesterol

Direct bilirubin, read against your total bilirubin result.

Unconjugated bilirubin test

Cholinesterases, including acetylcholinesterase and pseudocholinesterase, play critical roles in maintaining the proper functioning of the nervous system. Acetylcholinesterase aids in the transmission of nerve signals by breaking down acetylcholine, which facilitates communication across nerve endings. Reduced acetylcholinesterase activity can lead to an accumulation of acetylcholine at nerve endings, causing excessive nerve stimulation in various tissues and organs. On the other hand, pseudocholinesterase is primarily involved in the processing and metabolism of certain drugs. Two main reasons for conducting cholinesterase tests are: → Organophosphate pesticide exposure: These pesticides can hinder the activity of cholinesterase and pseudocholinesterase. Exposure can lead to severe symptoms in cases of acute poisoning or gradually develop with chronic exposure. Monitoring the levels of red blood cell acetylcholinesterase and serum pseudocholinesterase is crucial for detecting poisoning and monitoring individuals exposed to these chemicals, such as agricultural workers or those handling industrial chemicals. → Inherited pseudocholinesterase deficiency: Some individuals inherit a deficiency in the pseudocholinesterase enzyme due to genetic variations. This enzyme is essential for deactivating succinylcholine, a commonly used muscle relaxant during surgeries. Individuals with low levels or defective pseudocholinesterase may experience prolonged effects of the drug, leading to extended muscle paralysis and apnea following anesthesia. Pre-surgical pseudocholinesterase testing is essential for individuals with a family history of prolonged apnea after succinylcholine use to assess the risk of drug-related complications. Cholinesterase testing serves two primary purposes: → Detecting and diagnosing exposure to or poisoning by organophosphate pesticides. It's also employed for monitoring individuals at a higher risk of exposure to these compounds, notably those working in agricultural and chemical industries. Tests typically involve examining levels of red blood cell acetylcholinesterase (AChE) and serum pseudocholinesterase (PChE). → Conducted before a surgical procedure, it assesses the susceptibility of individuals with a history of post-operative paralysis following the administration of succinylcholine, a common muscle relaxant used in anesthesia. Pseudocholinesterase testing is standard in such cases, often accompanied by a dibucaine inhibition test to evaluate the enzyme's diminished activity.

helps in the assessment of liver fibrosis

to estimate the degree of liver fibrosis

Fibrosis Score is a non-invasive estimate of liver scarring (fibrosis) derived from routine blood tests—typically AST, ALT, platelet count—and sometimes age or body measurements. It helps determine whether liver injury from fatty liver disease (MASLD/NASH), hepatitis B or C, or alcohol use has progressed to advanced fibrosis or cirrhosis. In general, a low score indicates minimal scarring and low risk, while a high score points to significant fibrosis and the need for further evaluation, often via transient elastography (FibroScan®) or specialist assessment. Clinicians use this score to monitor liver health over time, reduce the need for biopsy, and guide treatment and lifestyle changes aimed at halting or reversing damage. If your score falls into the low or minimal range, it suggests little to no fibrosis and likely good liver function—reassuring evidence that advanced damage is not present right now. Even so, keeping your liver healthy matters: prioritize a balanced diet, regular exercise, healthy body weight, limited alcohol, and management of metabolic risks (blood sugar, cholesterol, blood pressure). Your clinician may advise periodic re-checks of liver enzymes and fibrosis markers—typically every 1–3 years—to confirm stability and catch early changes promptly.

Fibrosis Stage (FibroTest® → METAVIR) expresses how much liver scarring you likely have by converting a FibroTest score (f) into METAVIR stages: f ≥ 0.00–0.21 = F0 (no fibrosis); >0.21–0.27 = F0–F1 (no fibrosis); >0.27–0.31 = F1 (minimal fibrosis); >0.31–0.48 = F1–F2 (minimal fibrosis); >0.48–0.58 = F2 (moderate fibrosis); >0.58–0.72 = F3 (advanced fibrosis); >0.72–0.74 = F3–F4 (advanced fibrosis); >0.74–1.00 = F4 (severe fibrosis/cirrhosis). Lower stages (F0–F1) suggest little to no scarring and routine lifestyle-focused care with periodic rechecks; mid stages (F1–F2) indicate rising risk and may warrant confirmatory elastography (e.g., FibroScan®) and more active treatment of the cause (metabolic, viral, alcohol-related); advanced stages (F3–F4) signal substantial scarring, higher complication risk, and the need for specialist management, imaging, and surveillance. Always interpret your number in clinical context and with the reference ranges printed on your report.

Liver enzyme

Aids in the diagnosis of primary biliary cirrhosis (PBC)

Necroinflammatory Activity Grade reflects the level of active inflammation and liver cell injury occurring at the time of testing. It complements the Fibrosis Stage by showing how active the disease process is, rather than how much scarring has already formed. This grade is based on blood markers (such as ALT, AST, GGT, bilirubin, and others) and corresponds to the METAVIR scale: A0 (no activity), A1 (mild), A2 (moderate), and A3 (severe). A low grade (A0–A1) indicates stable or inactive liver disease with little current inflammation, while higher grades (A2–A3) mean that the liver is actively inflamed and at risk of progressive fibrosis if not addressed. Elevated grades are commonly linked to conditions such as fatty liver disease (MASLD/NASH), hepatitis B or C, alcohol-related liver injury, or autoimmune hepatitis. Managing the underlying cause—through treatment, alcohol avoidance, weight control, and metabolic care—can reduce inflammation and help protect against long-term liver damage.

Necroinflammatory Activity Score measures the level of active inflammation and liver cell injury, helping assess how “active” liver disease is at the time of testing. Unlike the Fibrosis Score, which reflects long-term scarring, this score indicates current inflammatory activity caused by conditions such as fatty liver disease (MASLD/NASH), viral hepatitis (B or C), or alcohol-related liver injury. Results range from A0 (no inflammation) to A3 (severe activity), with higher scores suggesting more intense inflammation and greater risk for future fibrosis progression. A low score (A0–A1) is reassuring and indicates stable liver health, while moderate to high scores (A2–A3) mean active inflammation that requires medical attention and lifestyle or treatment changes. Managing underlying causes, limiting alcohol, maintaining a healthy weight, and controlling blood sugar and cholesterol can help reduce inflammation and improve liver function over time.

used as an indicator of nutritional requirements

Prealbumin, also called transthyretin, is one of the major proteins in the blood and is produced primarily by the liver. Its functions are to carry thyroxine (the main thyroid hormone) and vitamin A throughout the body. Until recently, the prealbumin test was believed to be a useful marker of nutritional status and was used to help detect and diagnose protein-calorie malnutrition as well as to monitor people receiving total parenteral nutrition (TPN, getting nutrition via a solution injected into a vein). It was also used to monitor changes in nutritional status in someone undergoing hemodialysis as part of treatment for kidney disease. Some healthcare practitioners continue to use the test in this manner; however, there is controversy because changes in prealbumin may actually reflect other conditions such as inflammation, infection, or trauma. As such, it has been suggested by some health professionals that the prealbumin test should no longer be used to assess nutritional status or diagnose malnutrition. However, others believe that the test can be useful in determining prognosis for people who are critically ill, hospitalized, and/or at risk of poor outcomes and can prompt nutritional and other support that may improve patient outcomes. Additional notes: Although the names are similar, prealbumin and albumin are completely different molecules. They are both proteins made by the liver, however, and both have been used historically to evaluate nutritional status. Serum/plasma (or blood) albumin is now more often used to screen for and help diagnose liver or kidney disease and is tested on a blood sample. The urine albumin test (in the past, called a microalbumin test) detects and measures albumin in the urine as an early indicator of kidney damage.