. Author manuscript; available in PMC: 2022 Sep 8.

Published in final edited form as: Metab Target Organ Damage. 2021 Jul 2;1(1):2. doi: 10.20517/mtod.2021.02

Table 3.

‟Normally abnormal” labs in NAFLD

Laboratory test	Comments
Platelets	• Most commonly develops with advanced fibrosis and portal hypertension in all etiologies of liver disease • Can be seen in NAFLD before development of above
High-density	• Low levels can be seen as part of metabolic syndrome in NAFLD and are common in decompensated cirrhosis
lipoprotein	• Low levels portend poor prognosis and are associated with adrenal dysfunction in decompensated cirrhosis
Autoantibodies	• Seen in 20%−35% of NAFLD patients • ANA > > ASMA^*; unclear if changes prognosis • If concern for possible autoimmune liver disease, requires biopsy to differentiate from NAFLD
Ferritin	• Hyperferritinemia associated with worse histologic activity, portal hypertension-related decompensations, hepatorenal syndrome, and mortality • Markedly elevated levels, particularly if % saturation is high, require HFE genetic testing to rule out hereditary hemochromatosis
Vitamin B₁₂	• Levels elevated in both acute and chronic liver disease secondary to abnormal clearance of the plasma binding protein haptocorrin and release of stored B₁₂ from hepatocytes • Measurement of methylmalonic acid (MMA) is necessary to assess for deficiency in liver disease

ANA positive in 13%−21% and ASMA positive in 3%−5% of NAFLD patients. ANA: Antinuclear antibody; ASMA: anti-smooth muscle antibody; HFE: homeostatic iron regulator gene; NAFLD: nonalcoholic fatty liver disease.