Jaundice laboratory findings: Difference between revisions
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*** [[Pregnancy]] | *** [[Pregnancy]] | ||
*** Drugs | *** Drugs | ||
*** More rarely | *** More rarely [[primary biliary cirrhosis]] | ||
** Very high Serum transaminases may revealed [[viral hepatitis]] as the underlying disease. | ** Very high Serum transaminases may revealed [[viral hepatitis]] as the underlying disease. | ||
*** [[Aspartate aminotransferase]] (AST) is raised more than [[alanine aminotransferase]] (ALT) in [[cirrhosis]], intrahepatic [[neoplasia]], [[hemolytic]] jaundice and [[alcoholic hepatitis]].<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> | *** [[Aspartate aminotransferase]] (AST) is raised more than [[alanine aminotransferase]] (ALT) in [[cirrhosis]], intrahepatic [[neoplasia]], [[hemolytic]] jaundice and [[alcoholic hepatitis]].<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> | ||
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** For more information about hepatitis serology [[Viral hepatitis|click here]]. | ** For more information about hepatitis serology [[Viral hepatitis|click here]]. | ||
* Serum antinuclear antibodies (ANAs), [[anti-smooth muscle antibody]] (ASMA): | * Serum antinuclear antibodies (ANAs), [[anti-smooth muscle antibody]] (ASMA): | ||
** Elevated [[antimitochondrial antibodies]] may revealed | ** Elevated [[antimitochondrial antibodies]] may revealed [[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> | ||
** [[Anti-nuclear antibody|Antinuclear antibody]] ([[ANA]]) may be raised in [[ | ** [[Anti-nuclear antibody|Antinuclear antibody]] ([[ANA]]) may be raised in [[primary biliary cirrhosis]](20-30%).<ref name="pmid182153152" /> | ||
* Serum [[immunoglobulins]] and serum [[electrophoresis]] : | * Serum [[immunoglobulins]] and serum [[electrophoresis]] : | ||
** Elevated [[IgG]] may revealed [[acute hepatitis]] as the underlying disease for jaundice. | ** Elevated [[IgG]] may revealed [[acute hepatitis]] as the underlying disease for jaundice. | ||
** Elevated [[IgM]] may revealed | ** Elevated [[IgM]] may revealed [[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> | ||
* [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin]] levels: | * [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin]] levels: | ||
** Decreased alpha-1-antitrypsin may revealed [[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> | ** Decreased alpha-1-antitrypsin may revealed [[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> | ||
Revision as of 17:38, 21 February 2018
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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]
- An elevated concentration of serum total bilirubin.
- The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories.
- Jaundice usually becomes clinically apparent when the serum total bilirubin concentration is greater than 2 to 3 mg/dL
- Threshold for clinically apparent jaundice may vary among patients.
- 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:
- Decreased RBC and HGB may revealed haemolysis as the underlying disease for jaundice.
- Erythrocyte sedimentation rate may be rise in primary biliary cirrhosis.[2]
- Elevated lactate dehydrogenase is diagnostic for hemolysis as the underlying disease for jaundice.
- Liver Function Tests:
- Alkaline phosphatase: Elevated alkaline phosphatase may reflect the followings:[3]
- Gallstones causing bile duct obstruction
- Pancreatic cancer
- Pregnancy
- Drugs
- More rarely primary biliary cirrhosis
- Very high Serum transaminases may revealed viral hepatitis as the underlying disease.
- Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in cirrhosis, intrahepatic neoplasia, hemolytic jaundice and alcoholic hepatitis.[4]
- ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
- Gamma-glutamyltransferase (GGT):[5][6]
- A raised mean corpuscular volume (MCV) with raised GGT may revealed alcohol abuse and, if accompanied by raised ALT, revealed liver cell damage as the underlying disease for jaundice.
- Very high GGT levels (x 10 normal) may revealed Biliary obstruction and hepatic malignancies as the underlying disease for jaundice.
- Raised GGT with raised alkaline phosphatase (more than 3 times) may revealed cholestasis as the underlying disease for jaundice.
- Alkaline phosphatase: Elevated alkaline phosphatase may reflect the followings:[3]
- Hepatitis serology:
- For more information about hepatitis serology click here.
- Serum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA):
- Elevated antimitochondrial antibodies may revealed primary biliary cirrhosis(90-95% of patients).[2]
- Antinuclear antibody (ANA) may be raised in primary biliary cirrhosis(20-30%).[2]
- Serum immunoglobulins and serum electrophoresis :
- Elevated IgG may revealed acute hepatitis as the underlying disease for jaundice.
- Elevated IgM may revealed primary biliary cirrhosis as the underlying disease for jaundice.[2]
- Alpha-1-antitrypsin levels:
References
- ↑ Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty
|title=(help) - ↑ 2.0 2.1 2.2 2.3 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.
- ↑ 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.
- ↑ 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.