Liver Care

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood. Many tests can be performed on the liver, but most of them do not measure the overall function of the liver. The most widely used tests to check liver function are the albumin test and the bilirubin test. These tests measure how well the liver creates albumin, a protein, and disposes of bilirubin, a waste product of the blood.

Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease. Conditions other than liver disease or damage can lead to abnormal liver function test results. Test results can be normal in people who have liver disease or damage. Albumin is the main protein made by the liver. It performs many important bodily functions. For instance, albumin:

• stops fluid from leaking out of blood vessels
• Nourishes tissues
• Transports hormones, vitamins and other substances throughout the body.

An albumin test measures how well the liver is making this particular protein. A low result on this test indicates that the liver is not functioning properly. Bilirubin, on the other hand, is a waste product ordinarily processed by the liver. This waste product is caused by the breakdown of red blood cells. It passes through the liver before being excreted through your stool. If your liver is damaged, it cannot properly process bilirubin. This will lead to an abnormally high level of bilirubin in the blood. Thus, a high result on the bilirubin test indicates that the liver is not functioning properly.

Liver tests are performed to determine if the liver is working correctly. The liver performs a number of vital bodily functions, such as:

• removing contaminants from the blood
• converting the nutrients from the food you eat
• storing minerals and vitamins
• regulating blood clotting
• producing proteins, enzymes, and bile
• making factors that fight infection
• removing bacteria from the blood
• processing substances that could harm the body
• maintaining hormone balances

Problems with the liver can make a person very sick and can lead to death. Symptoms of a liver disorder include:

• weakness
• fatigue or loss of energy
• weight loss
• jaundice (yellow skin and eyes)
• symptoms of nephritic syndrome (swelling around the eyes, belly, and legs)
• discoloured bodily discharge (dark urine or light stools)
• nausea
• vomiting
• diarrhoea
• abdominal pain

The different liver function tests can check for infection, monitor the progression or treatment of a disease, and test for the side effects of certain medications.

Why NABL?

National Accreditation Board for Testing and Calibration Laboratories (NABL) is an autonomous body under the aegis of Department of Science & Technology, Government of India, and is registered under the Societies Act 1860. NABL has been established with the objective to provide Government, Industry Associations and Industry in general with a scheme for third-party assessment of the quality and technical competence of testing and calibration laboratories. Government of India has authorized NABL as the accreditation body for Testing and Calibration Laboratories.

Laboratory accreditation uses criteria and procedures specifically developed to determine technical competence. Specialist technical assessors conduct a thorough evaluation of all factors in a laboratory that affect the production of test or calibration data. The criteria are based on the international standards called ISO/IEC 17025 or ISO 15189, which are used for evaluating laboratories throughout the world.

Laboratory accreditation bodies use this standard specifically to assess factors relevant to the laboratory’s technical competence, including the:-

• technical competence of staff
• validity and appropriateness of test methods
• traceability of measurements and calibrations to national standards
• suitability, calibration and maintenance of test equipment
• testing environment
• sampling, handling and transportation of test items
• quality assurance of test and calibration data

By this process, laboratory accreditation aims at assuring that the laboratory’s test or calibration data are accurate and reliable.The accreditation granted to a laboratory shall remain valid for a period of 2 years subject to satisfactory periodical (annual) surveillance. Laboratory also has an option to widen the scope of accreditation in terms of specific tests and calibrations. NABL has established policies and procedures for granting, suspending and withdrawal of accreditation of accreditation in accordance with ISO/IEC 17011:2004.
Medilab has gained international recognition in the field of diagnostic services after receiving NABL accreditation (ISO 15189:2007).

FBS (Fasting Blood Sugar) & PPBS (Post Prandial Blood Sugar)

Glucose is a type of sugar that serves as the main source of energy used by the body. Insulin is a hormone that helps the body's cells to use the glucose. Excess or shortage of insulin in the body causes an imbalance of the blood glucose in the body, leading to its severe drop or drastic increase in the blood. Blood glucose levels that remain high over time can cause damage to the eyes, kidneys, nerves and blood vessels. Chronic low glucose levels can lead to brain and nerve damage.

Fasting blood sugar (FBS): It measures blood sugar levels either after 8-12 hrs. or overnight fast and it is often the first test done to check for pre-diabetes and diabetes. Blood sugar levels outside the normal range may be an indicator of a medical condition. Fasting means refraining from eating or drinking any liquids other than water for eight hours. It is used as a test for diabetes. After fasting, a carbohydrate metabolism test is conducted which measures blood glucose levels.

A Postprandial Plasma Glucose Test: is a blood test that measures blood glucose levels following a meal containing a set amount of carbohydrate. Postprandial Plasma Glucose Tests show how tolerant the body is to glucose. Normally, blood glucose levels increase slightly after eating. This increase causes the pancreas to release insulin, which assists the body in removing glucose from the blood and storing it for energy. People with diabetes may not produce or respond properly to insulin, which causes their blood glucose to remain elevated. Blood glucose levels that remain high over time can damage the eyes, kidneys, nerves, and blood vessels. 2-hour postprandial blood test measures blood glucose exactly 2 hours after eating a meal, timed from the start of the meal. By this point blood sugar has usually gone back down in healthy people, but it may still be elevated in people with diabetes. Thus, it serves as a test of whether a person may have diabetes, or of whether a person who has diabetes is successfully controlling their blood sugar.

Why Veins appear blue?

The blood vessels in our bodies have slight shades of blue and red and these shades are the outcome of oxygen content in the “red blood cells.” Haemoglobin gives these cells their red colour (blood also has “white blood cells,” which are immune cells that lack haemoglobin). In a healthy person, the arteries that carry blood away from the heart are full with oxygen. This oxygen causes the blood to be bright red colour that penetrates the walls of the vessels. When this blood flows through the capillaries in the tissues, the haemoglobin releases the oxygen to the surrounding tissue cells, where it is converted to energy molecules.

The blood flowing from the capillaries into the veins on its way back to the heart and lungs have less oxygen, so blood in veins appears bluish-red. When looking at the skin, we can’t see the red arteries because they are located deep to keep them out of danger or harm. Instead, we see only veins. And they appear blue rather than red, especially in individuals with little melanin pigment in their skin (The pigment that gives human skin, hair, and eyes their colour. Dark-skinned people have more melanin in their skin than light-skinned people have).

In some people with lesser lung function, or mountaineers climbing high altitudes without bottled oxygen, the blood flowing from their heart to the tissues might be more bluish in tint than normal. This difference can be detected by looking at the colour of certain tissues with capillaries that are dense and close to the surface, such as the lips and nail-beds of the fingers. As a result, these individuals will appear to have blue lips and fingernails and this is not a good sign, because they lack oxygen in their tissues.

Hepatitis- A growing pain

Hepatitis means injury to the liver with inflammation of the liver cells. Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Viruses cause most cases of hepatitis. The type of hepatitis is named for the virus that causes it; for example, hepatitis A, hepatitis B or hepatitis C. Drug or alcohol use can also cause hepatitis. In other cases, your body mistakenly attacks healthy cells in the liver. There are three main types of hepatitis that are caused by a virus, A, B & C.

Hepatitis A
This is caused by eating infected food or water. The food or water is infected with a virus called HAV (hepatitis A virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease.

Hepatitis B

This is an STD (sexually transmitted disease). It is caused by the virus HBV (hepatitis B virus) and is spread by contact with infected blood, semen, and some other body fluids. You get hepatitis B by:

• Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids).
• Having your skin perforated with unsterilised needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way. Sharing personal items, such as a toothbrush or razor, with an infected person.
• A baby can become infected through his mother's milk if she is infected.
• Being bitten by someone who is infected.

Hepatitis C

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces are never a route of transmission in hepatitis C. Donated blood is also tested for hepatitis C.

The initial phase of hepatitis is called the acute phase. The symptoms are like a mild flu, and may include:

• Diarrhea
• Fatigue
• Loss of appetite
• Mild fever
• Muscle or joint aches
• Nausea
• Slight abdominal pain
• Vomiting
• Weight loss.

The acute phase is not usually dangerous, unless it develops into the fulminant or rapidly progressing form, which can lead to death. As the patient gets worse, these symptoms may follow:

• Circulation problems (only toxic/drug-induced hepatitis)
• Dark urine
• Dizziness (only toxic/drug-induced hepatitis)
• Drowsiness (only toxic/drug-induced hepatitis)
• Enlarged spleen (only alcoholic hepatitis)
• Headache (only toxic/drug-induced hepatitis)
• Hives
• Itchy skin
• Light colored feces, the feces may contain pus
• Yellow skin, whites of eyes, tongue (jaundice).

Patient outcomes after the acute phase depend on various factors, especially the type of hepatitis.

Safe- Donated Blood

Blood is tested to determine the donor's ABO group (A, B, O, AB) and Rh type (positive or negative). This is critical in selecting compatible blood for a patient in need of a transfusion. Blood that has been donated is tested before giving it to any recipient. The various test that are carried out is crucial for all recipients as it is important that the blood that is used is not impure of infectious in any form. 

ANTIBODY DETECTION TEST
All donors are tested to determine if their blood contains unexpected antibodies to red blood cell antigens (genetic marker). These antibodies, if not identified, can cause problems in a blood recipient.

TESTS FOR INFECTIOUS DISEASES
Screening donated blood for infectious diseases that can be transmitted through blood transfusion is very important in ensuring safety. A positive screening test in any of the following tests for infectious disease is followed by a confirmatory test, since it is possible to have false positive test results. A false positive occurs when the screening test is positive but it cannot be confirmed. This means a donor was not exposed to the infectious agent being tested for but the screening test was positive. The following eight tests are performed on each unit of donated blood:

1. Hepatitis B Surface Antigen (HBsAg) and Core Antibody (anti-HBc): The hepatitis B virus has an inner core and an outer envelope (the surface). The HBsAg test detects the outer envelope or surface of the virus. The anti-HBc tests for the presence of antibodies to the inner core of the hepatitis B virus. In the absence of any other positive test for hepatitis B, the presence of antibodies to HBc suggests the individual may have had past exposure to the hepatitis B virus and it is unlikely he/she is infectious.
2. Hepatitis C Virus Antibody (anti-HCV) and Nucleic Acid Test (NAT): Two tests are Video Clip done to detect hepatitis C infection. The anti-HCV test detects antibodies to the hepatitis C virus. A positive result suggests the donor has been exposed to the hepatitis C virus and may be infectious. The second test detects RNA, the genetic material, of the hepatitis C virus. 
3. Alanine-Aminotransferase Test (ALT): The ALT measures the level of the liver enzyme (ALT) that is found in the blood. An elevated result suggests the possibility of abnormal liver function, but this may not necessarily be related to viral hepatitis. This test was initiated prior to more sophisticated tests performed today.
4. Human T-Lymphotrophic Virus Type I and Type II (HTLV I/II) Antibody: HTLV I/II testing detects antibody to the HTLV-I and HTLV-II viruses. HTLV-I has been associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-I is associated with myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-II has not been clearly associated with any diseases, but may lead to subtle abnormalities of the immune system.
   
5. Syphilis Antibody: This test has been performed on blood donors since shortly after World War II when the rate of infection was much higher. The risk of transmitting syphilis through a blood transfusion today is very small, since the rate of infection is low in blood donors and the organism causing syphilis is very fragile and unlikely to survive blood storage. 
6. Human Immunodeficiency Virus 2 (HIV-1/2) Combo Antibody and Nucleic Acid Amplification Testing (NAT): HIV-1 and/or HIV-2 virus cause acquired immunodeficiency syndrome, or AIDS. HIV-1 is more common in the United States while HIV-2 is prevalent in Western Africa. Two tests are done for detecting HIV. One screens for antibodies to both HIV-1 and HIV-2 viruses. The other detects RNA, the genetic material, of the HIV-1 virus.

Criteria to keep in mind while choosing a Lab

Diagnostic Labs are growing and increasing in number and sometimes it becomes difficult to identify what aspects of a lab we should consider while choosing one. Different advertisements and technical aspects provoke us to go forward in choosing a lab. But what should our major concentrations focus on?

1. Fully Automated process (to avoid man made errors)

A Lab that is fully automated and mechanized is considered to provide more accurate and error free results. The testing of samples can be specific and detailed. And this also helps to reduce man-made errors that may otherwise occur.

2. Lab should have a resident subject expert- Technically qualified

Resident subject experts refer to those who are technically qualified to advice and correct mechanical errors, if any. In this way, the quality of the lab’s output is not disturbed and results will be as qualified as of the automated ones.

3. NABL Accreditation- National Accreditation Board for Testing and Calibration Laboratories

Accreditation assists the Indian industries to enhance the quality and reliability of Indian goods in the domestic market and exports, thereby, catalysis the growth of Indian economy. WTO has identified non-acceptance of test results and measurement data as Technical Barrier to Trade (TBT) and accreditation is considered to be the first essential step towards removing such technical barriers. NABL provides accreditation in all major fields of Science and Engineering such as Biological, Chemical, Electrical, Electronics, Mechanical, Fluid-Flow, Non-Destructive, Photometry, Radiological, Thermal & Forensics under testing facilities and Electro-Technical, Mechanical, Fluid Flow, Thermal, Optical & Radiological under Calibration facilities. NABL also offers accreditation for medical testing laboratories.

4. Online Result Availability

Customers must be able to avail results online. In this way, people who are not able to come till the lab again can get their results in the electronic format, either through e-mails, mobile messages, or online checking of results and reports. This makes convenience for the customers.

5. Empanelled Doctors

The opinion and direction of doctors and standards followed around the world must be applicable in a lab you choose to diagnose yourself. These standards will help recognize the quality of the lab. These are the criteria that one must keep in mind while selecting a lab for their diagnosis. The lab with the above mentioned criteria would probably give you the most accurate results possible.