Jaundice laboratory findings
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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.