Autoimmune hepatitis laboratory findings: Difference between revisions

Jump to navigation Jump to search
Line 147: Line 147:
** Probable autoimmune hepatitis- 12-17
** Probable autoimmune hepatitis- 12-17
|-
|-
| colspan="2" |AP, alkaline phosphatase; AST, aspartate aminotransferase; ALT, alanine aminotransferase; IgG, immunoglobulin G; ULNupper limit of the normal range; HLA, human leukocyte antigen; ANA, antinuclear antibodies; SMA, smooth muscle antibodies; anti-LKM1, antibodies to liver kidney microsome type 1; AMA, antimitochondrial antibodies.☃☃Adapted from Alvarez F, ''et al''. J Hepatol 1999;31:929–938, with permission of Elsevier BV and the European Association for the Study of the Liver.<ref name="pmid10580593">{{cite journal |vauthors=Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M |title=International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis |journal=J. Hepatol. |volume=31 |issue=5 |pages=929–38 |year=1999 |pmid=10580593 |doi= |url=}}</ref>
| colspan="2" |AP, alkaline phosphatase; AST, aspartate aminotransferase; ALT, alanine aminotransferase; IgG, immunoglobulin G; ULNupper limit of the normal range; HLA, human leukocyte antigen; ANA, antinuclear antibodies; SMA, smooth muscle antibodies; anti-LKM1, antibodies to liver kidney microsome type 1; AMA, antimitochondrial antibodies.☃☃Adapted from Alvarez F, ''et al''. J Hepatol 1999;31:929–938, with permission of Elsevier BV and the European Association for the Study of the Liver.<ref name="pmid10580593">{{cite journal |vauthors=Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M |title=International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis |journal=J. Hepatol. |volume=31 |issue=5 |pages=929–38 |year=1999 |pmid=10580593 |doi= |url=}}</ref><ref name="pmid18924244">{{cite journal |vauthors=Czaja AJ |title=Performance parameters of the diagnostic scoring systems for autoimmune hepatitis |journal=Hepatology |volume=48 |issue=5 |pages=1540–8 |year=2008 |pmid=18924244 |doi=10.1002/hep.22513 |url=}}</ref>
|}
|}



Revision as of 14:27, 14 December 2017

Autoimmune hepatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating autoimmune hepatitis differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Diagnostic of choice

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Autoimmune hepatitis laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Autoimmune hepatitis laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Autoimmune hepatitis laboratory findings

CDC on Autoimmune hepatitis laboratory findings

Autoimmune hepatitis laboratory findings in the news

Blogs on Autoimmune hepatitis laboratory findings

Directions to Hospitals Treating Autoimmune hepatitis

Risk calculators and risk factors for Autoimmune hepatitis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  :Manpreet Kaur, MD [2]


Overview

Laboratory Findings

Following laboratory tests are used to diagnose autoimmune hepatitis:

  • Liver function tests
  • Alkaline phosphatase
  • Antibody assays
  • Serum protein and immunoglobulins
  • Complete blood count and differential count
  • Platelet count
  • ESR
  • Coombs test
  • Peripheral blood film

Laboratory findings consistent with the diagnosis of Autoimmune hepatitis include:

  • Increased serum aminotransferase levels (1.5-50 times reference values)
  • Increased serum immunoglobulin levels, primarily immunoglobulin G (1.2 to 3.0 times normal)
  • Seropositive for ANAs, anti-actin, SMAs, LKM-1, anti-liver cytosol 1 (anti-LC1) antibodies, SLA/LP autoantibodies or pANCA
Revised Scoring System of the International Autoimmune Hepatitis Group
Laboratory Findings Points
  • AP:AST (or ALT) ratio
    • <1.5
    • 1.5-3
    • >3

+2

0

-2

  • Serum globulin or IgG level above ULN
    • >2.0
    • 1.5-2.0
    • 1.5-1
    • <1

+3

+2

+1

0

  • ANA, SMA, or anti-LKM1
    • >1:80
    • 1:80
    • 1:40
    • <1:40

+3

+2

+1

0

  • AMA positive
-4
  • Hepatitis markers
    • Positive
    • Negative

-3

+3

  • Hepatotoxic drug exposure
    • Positive
    • Negative
-4

+1

  • Average alcohol intake (g/day)
    • <25
    • >60
+2

-2

  • Histologic findings
    • Interface hepatitis
    • Lymphoplasmacytic infiltrate
    • Rosette formation
    • Biliary changes
    • Other atypical changes
    • None of above

+3

+1

+1

-3

-3

-5

  • Concurrent immune disease, including celiac disease
+2
  • Other autoantibodies
+2
  • HLA DRB1*03 or DRB1*04
+1
  • Response to corticosteroids
    • Complete
    • Relapse after drug withdrawal
+2

+3

  • Aggregate score pretreatment
    • Definite autoimmune hepatitis - >15
    • Probable autoimmune hepatitis -10 -15
  • Aggregate score post-treatment
    • Definite autoimmune hepatitis - >17
    • Probable autoimmune hepatitis- 12-17
AP, alkaline phosphatase; AST, aspartate aminotransferase; ALT, alanine aminotransferase; IgG, immunoglobulin G; ULNupper limit of the normal range; HLA, human leukocyte antigen; ANA, antinuclear antibodies; SMA, smooth muscle antibodies; anti-LKM1, antibodies to liver kidney microsome type 1; AMA, antimitochondrial antibodies.☃☃Adapted from Alvarez F, et al. J Hepatol 1999;31:929–938, with permission of Elsevier BV and the European Association for the Study of the Liver.[1][2]

References

  1. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M (1999). "International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis". J. Hepatol. 31 (5): 929–38. PMID 10580593.
  2. Czaja AJ (2008). "Performance parameters of the diagnostic scoring systems for autoimmune hepatitis". Hepatology. 48 (5): 1540–8. doi:10.1002/hep.22513. PMID 18924244.

Template:WH Template:WS