Jaundice laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Jaundice}} | {{Jaundice}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{FKH}} | ||
==Overview== | ==Overview== | ||
An elevated concentration of serum total [[bilirubin]] is diagnostic for jaundice. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. Hyperbilirubinemia can be further categorized as conjugated or unconjugated. Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L) revealed conjugated hyperbilirubinemia. In [[Unconjugated bilirubin|unconjugated]] hyperbilirubinemia conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL, or less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L). | |||
==Laboratory Findings== | |||
Laboratory findings consistent with the diagnosis of jaundice include:<ref name="pmid21250253">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Stillman AE |title= |journal= |volume= |issue= |pages= |year= |pmid=21250253 |doi= |url=}}</ref><ref name="pmid14765767">{{cite journal |vauthors=Roche SP, Kobos R |title=Jaundice in the adult patient |journal=Am Fam Physician |volume=69 |issue=2 |pages=299–304 |date=January 2004 |pmid=14765767 |doi= |url= |author=}}</ref> | |||
=== Elevated biliribin === | |||
* An elevated concentration of serum total [[bilirubin]] (Normal 0 - 1 mg/dL). | |||
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated: | * Hyperbilirubinemia can be further categorized as conjugated or unconjugated: | ||
** Conjugated hyperbilirubinemia: | ** [[Conjugated bilirubin|Conjugated]] hyperbilirubinemia: | ||
*** | *** Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L). | ||
*** Direct | *** Direct bilirubin >1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL (85 micromol/L). | ||
** | *** More than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L). | ||
*** | ** [[Unconjugated bilirubin|Unconjugated]] hyperbilirubinemia: | ||
** | *** Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL. | ||
*** Less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L). | |||
=== Liver function tests === | |||
* [[ | * '''[[Alkaline phosphatase]]:''' | ||
** Elevated [[alkaline phosphatase]] may suggest the following as underlying cause of jaundice:<ref name="pmid6966832">{{cite journal |vauthors=Ellis G, Goldberg DM, Spooner RJ, Ward AM |title=Serum enzyme tests in diseases of the liver and biliary tree |journal=Am. J. Clin. Pathol. |volume=70 |issue=2 |pages=248–58 |year=1978 |pmid=696683 |doi= |url=}}</ref> | |||
* [[ | *** [[Gallstones]] causing bile duct obstruction | ||
* [[ | *** [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r | ||
*** [[Pregnancy]] | |||
*** Drugs | |||
* [[ | *** Rarely [[primary biliary cirrhosis]] | ||
* '''[[Transaminase|Liver transaminases]]''' | |||
* [[ | ** Very high serum [[transaminases]] may suggest [[viral hepatitis]] as the underlying disease.<ref name="pmid10781624">{{cite journal |vauthors=Pratt DS, Kaplan MM |title=Evaluation of abnormal liver-enzyme results in asymptomatic patients |journal=N. Engl. J. Med. |volume=342 |issue=17 |pages=1266–71 |year=2000 |pmid=10781624 |doi=10.1056/NEJM200004273421707 |url=}}</ref> | ||
** Most causes of liver cell injury are associated with a greater increase in ALT than AST. | |||
** AST to ALT ratio of 2:1 or greater is suggestive of alcoholic liver disease. | |||
* '''[[Gamma-glutamyltransferase]] (GGT):'''<ref name="pmid696683">{{cite journal |vauthors=Ellis G, Goldberg DM, Spooner RJ, Ward AM |title=Serum enzyme tests in diseases of the liver and biliary tree |journal=Am. J. Clin. Pathol. |volume=70 |issue=2 |pages=248–58 |year=1978 |pmid=696683 |doi= |url=}}</ref><ref name="pmid6104563">{{cite journal |vauthors=Goldberg DM |title=Structural, functional, and clinical aspects of gamma-glutamyltransferase |journal=CRC Crit Rev Clin Lab Sci |volume=12 |issue=1 |pages=1–58 |year=1980 |pmid=6104563 |doi= |url=}}</ref> | |||
** A raised [[mean corpuscular volume]] ([[MCV]]) with raised [[GGT]] may suggest alcohol abuse. If accompanied by raised ALT, it suggests [[liver]] cell damage as the underlying disease for jaundice. | |||
** Very high [[GGT]] levels (x 10 normal) may suggest [[biliary obstruction]] and hepatic malignancies as the underlying disease for jaundice. | |||
** Raised GGT with raised alkaline phosphatase (more than 3 times) may suggest [[cholestasis]] as the underlying disease for jaundice. | |||
=== Complete blood count === | |||
* Decreased [[red blood cells]] and [[hemoglobin]] may suggest [[hemolysis]] as the underlying disease for jaundice. | |||
=== Erythrocyte sedimentation rate === | |||
* [[Erythrocyte sedimentation rate]] may be elevated in [[primary biliary cirrhosis]] as the underlying disease for jaundice.<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref> | |||
=== Lactate dehydrogenase levels === | |||
* Elevated [[lactate dehydrogenase]] is diagnostic of [[hemolysis]] as the underlying disease for jaundice. | |||
=== Serology: === | |||
==== Hepatitis serology ==== | |||
* For more information about viral hepatitis serology [[Viral hepatitis|click here]]. | |||
==== Autoimmune antibodies ==== | |||
* '''Anti-nuclear antibodies (ANAs)''' | |||
** [[Anti-nuclear antibody|Antinuclear antibody]] ([[ANA]]) may be raised in [[primary biliary cirrhosis]](20-30%).<ref name="pmid182153152" /> | |||
* '''Anti-smooth muscle antibody (ASMA):''' | |||
** [[Anti-smooth muscle antibodies|Anti-smooth muscle antibodie]]<nowiki/>s are [[Antibody|antibodies]] ([[Immunoglobulin|immunoglobulins]]) formed against [[smooth muscle]]. These antibodies are typically associated with [[autoimmune hepatitis]].<ref name="pmid1589647">{{cite journal |vauthors=Tomizawa Y, Noishiki Y, Okoshi T, Koyanagi H |title=[A rabbit model for evaluation of a small-caliber vascular graft] |language=Japanese |journal=Kokyu To Junkan |volume=40 |issue=5 |pages=481–4 |date=May 1992 |pmid=1589647 |doi= |url=}}</ref> | |||
* '''Anti-mitochondrial antibodies (AMA):''' | |||
** Elevated [[antimitochondrial antibodies]] suggests [[primary biliary cirrhosis]] (90-95% of patients).<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref> | |||
==== Serum electrophoresis ==== | |||
* Elevated [[IgG]] may suggest [[acute hepatitis]] as the underlying disease for jaundice.<ref name="pmid21483590">{{cite journal |vauthors=Fallatah HI, Akbar HO |title=Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis |journal=Libyan J Med |volume=5 |issue= |pages= |date=January 2010 |pmid=21483590 |pmc=3071169 |doi=10.3402/ljm.v5i0.4857 |url= |author=}}</ref> | |||
* Elevated [[IgM]] may suggest [[primary biliary cirrhosis]] as the underlying disease for jaundice.<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref> | |||
=== Enzyme levels === | |||
==== Alpha-1-antitrypsin levels: ==== | |||
* Decreased alpha-1-antitrypsin may suggests [[cirrhosis]] as the underlying disease for jaundice.<ref name="pmid23355203">{{cite journal |vauthors=Greene DN, Elliott-Jelf MC, Straseski JA, Grenache DG |title=Facilitating the laboratory diagnosis of α1-antitrypsin deficiency |journal=Am. J. Clin. Pathol. |volume=139 |issue=2 |pages=184–91 |date=February 2013 |pmid=23355203 |doi=10.1309/AJCP6XBK8ULZXWFP |url= |author=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
Latest revision as of 22:27, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
An elevated concentration of serum total bilirubin is diagnostic for jaundice. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. Hyperbilirubinemia can be further categorized as conjugated or unconjugated. Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L) revealed conjugated hyperbilirubinemia. In unconjugated hyperbilirubinemia conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL, or less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
Laboratory Findings
Laboratory findings consistent with the diagnosis of jaundice include:[1][2]
Elevated biliribin
- An elevated concentration of serum total bilirubin (Normal 0 - 1 mg/dL).
- Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
- Conjugated hyperbilirubinemia:
- Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L).
- Direct bilirubin >1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL (85 micromol/L).
- More than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
- Unconjugated hyperbilirubinemia:
- Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL.
- Less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
- Conjugated hyperbilirubinemia:
Liver function tests
- Alkaline phosphatase:
- Elevated alkaline phosphatase may suggest the following as underlying cause of jaundice:[3]
- Gallstones causing bile duct obstruction
- Pancreatic cancer
- Pregnancy
- Drugs
- Rarely primary biliary cirrhosis
- Elevated alkaline phosphatase may suggest the following as underlying cause of jaundice:[3]
- Liver transaminases
- Very high serum transaminases may suggest viral hepatitis as the underlying disease.[4]
- Most causes of liver cell injury are associated with a greater increase in ALT than AST.
- AST to ALT ratio of 2:1 or greater is suggestive of alcoholic liver disease.
- Gamma-glutamyltransferase (GGT):[5][6]
- A raised mean corpuscular volume (MCV) with raised GGT may suggest alcohol abuse. If accompanied by raised ALT, it suggests liver cell damage as the underlying disease for jaundice.
- Very high GGT levels (x 10 normal) may suggest biliary obstruction and hepatic malignancies as the underlying disease for jaundice.
- Raised GGT with raised alkaline phosphatase (more than 3 times) may suggest cholestasis as the underlying disease for jaundice.
Complete blood count
- Decreased red blood cells and hemoglobin may suggest hemolysis as the underlying disease for jaundice.
Erythrocyte sedimentation rate
- Erythrocyte sedimentation rate may be elevated in primary biliary cirrhosis as the underlying disease for jaundice.[7]
Lactate dehydrogenase levels
- Elevated lactate dehydrogenase is diagnostic of hemolysis as the underlying disease for jaundice.
Serology:
Hepatitis serology
- For more information about viral hepatitis serology click here.
Autoimmune antibodies
- Anti-nuclear antibodies (ANAs)
- Antinuclear antibody (ANA) may be raised in primary biliary cirrhosis(20-30%).[7]
- Anti-smooth muscle antibody (ASMA):
- Anti-smooth muscle antibodies are antibodies (immunoglobulins) formed against smooth muscle. These antibodies are typically associated with autoimmune hepatitis.[8]
- Anti-mitochondrial antibodies (AMA):
- Elevated antimitochondrial antibodies suggests primary biliary cirrhosis (90-95% of patients).[7]
Serum electrophoresis
- Elevated IgG may suggest acute hepatitis as the underlying disease for jaundice.[9]
- Elevated IgM may suggest primary biliary cirrhosis as the underlying disease for jaundice.[7]
Enzyme levels
Alpha-1-antitrypsin levels:
References
- ↑ Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty
|title=
(help) - ↑ Roche SP, Kobos R (January 2004). "Jaundice in the adult patient". Am Fam Physician. 69 (2): 299–304. PMID 14765767.
- ↑ Ellis G, Goldberg DM, Spooner RJ, Ward AM (1978). "Serum enzyme tests in diseases of the liver and biliary tree". Am. J. Clin. Pathol. 70 (2): 248–58. PMID 696683.
- ↑ Pratt DS, Kaplan MM (2000). "Evaluation of abnormal liver-enzyme results in asymptomatic patients". N. Engl. J. Med. 342 (17): 1266–71. doi:10.1056/NEJM200004273421707. PMID 10781624.
- ↑ Ellis G, Goldberg DM, Spooner RJ, Ward AM (1978). "Serum enzyme tests in diseases of the liver and biliary tree". Am. J. Clin. Pathol. 70 (2): 248–58. PMID 696683.
- ↑ Goldberg DM (1980). "Structural, functional, and clinical aspects of gamma-glutamyltransferase". CRC Crit Rev Clin Lab Sci. 12 (1): 1–58. PMID 6104563.
- ↑ 7.0 7.1 7.2 7.3 Kumagi T, Heathcote EJ (2008). "Primary biliary cirrhosis". Orphanet J Rare Dis. 3: 1. doi:10.1186/1750-1172-3-1. PMC 2266722. PMID 18215315.
- ↑ Tomizawa Y, Noishiki Y, Okoshi T, Koyanagi H (May 1992). "[A rabbit model for evaluation of a small-caliber vascular graft]". Kokyu To Junkan (in Japanese). 40 (5): 481–4. PMID 1589647.
- ↑ Fallatah HI, Akbar HO (January 2010). "Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis". Libyan J Med. 5. doi:10.3402/ljm.v5i0.4857. PMC 3071169. PMID 21483590.
- ↑ Greene DN, Elliott-Jelf MC, Straseski JA, Grenache DG (February 2013). "Facilitating the laboratory diagnosis of α1-antitrypsin deficiency". Am. J. Clin. Pathol. 139 (2): 184–91. doi:10.1309/AJCP6XBK8ULZXWFP. PMID 23355203.