Test explanation and related physiology

This test is used in the evaluation of suspected hepatocellular diseases. When disease or injury affects
the cells of these tissues, the cells lyse. The AST is released and picked up by the blood, and the serum
level rises. The amount of AST elevation is directly related to the number of cells affected by the disease
or injury. Furthermore, the elevation depends on the time after the injury that the blood is drawn. AST is
cleared from the blood in a few days. Serum AST levels become elevated 8 hours after cell injury, peak at
24 to 36 hours, and return to normal in 3 to 7 days. If the cellular injury is chronic, levels will be
persistently elevated.

Because AST exists within the liver cells, diseases that affect the hepatocytes cause elevated levels of this
enzyme. In acute hepatitis, AST levels can rise to 20 times the normal value. In acute extrahepatic
obstruction (e.g., gallstones), AST levels quickly rise to 10 times the normal value and fall swiftly. In
cirrhotic patients, the level of AST depends on the amount of active inflammation.

Serum AST levels are often compared with alanine aminotransferase (ALT, see p. 21) levels. The AST/ALT
ratio is usually greater than 1.0 in patients with alcoholic cirrhosis, liver congestion, or metastatic tumor
of the liver. Ratios less than 1.0 may be seen in patients with acute hepatitis, viral hepatitis, or infectious
mononucleosis. The ratio is less accurate if AST levels exceed 10 times the normal value.

Patients with acute pancreatitis, acute renal diseases, musculoskeletal diseases, or trauma may have a
transient rise in serum AST. Patients with red blood cell abnormalities, such as acute hemolytic anemia
and severe burns, also can have elevations of this enzyme.

Interfering factors

Exercise may cause increased levels.

Pyridoxine deficiency (beriberi or pregnancy), severe longstanding liver disease, uremia, or diabetic
ketoacidosis may cause decreased levels.

Drugs that may cause increased levels include antihypertensives, cholinergic agents, coumarin-type
anticoagulants, digitalis preparations, erythromycin, hepatotoxic medications, isoniazid, methyldopa,
opiates, oral contraceptives, salicylates, statins, and verapamil.

Procedure and patient care

See inside front cover for Routine Blood Testing.

Fasting: no

Blood tube commonly used: red

If possible, avoid giving the patient any IM injection because increased enzyme levels may result.
 Record the time and date of any IM injection given.

Record the exact time and date when the blood test is performed. This aids in the interpretation of the
temporal pattern of enzyme elevations.