Jaundice laboratory findings: Difference between revisions
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==Laboratory Findings== | ==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> | * 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> | ||
** An elevated concentration of serum total [[bilirubin]]. | ** An elevated concentration of serum total [[bilirubin]]. | ||
** The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. | *** 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/ | *** 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. | *** Threshold for clinically apparent jaundice may vary among patients. | ||
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated: | * Hyperbilirubinemia can be further categorized as conjugated or unconjugated: | ||
** [[Conjugated bilirubin|Conjugated]] hyperbilirubinemia: | ** [[Conjugated bilirubin|Conjugated]] hyperbilirubinemia: | ||
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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> | ||
*** ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction. | *** ALT is raised more than AST in [[acute hepatitis]] and in extrahepatic obstruction. | ||
** [[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> | ** [[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 revealed alcohol abuse and, if accompanied by raised ALT, revealed [[liver]] cell damage as the underlying disease for jaundice. | *** 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. | ||
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* Serum antinuclear antibodies (ANAs), [[anti-smooth muscle antibody]] (ASMA): | * Serum antinuclear antibodies (ANAs), [[anti-smooth muscle antibody]] (ASMA): | ||
** 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> | ** 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.<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 [[IgG]] may revealed [[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> | ||
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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]
- 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.
- An elevated concentration of serum total bilirubin.
- 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.[3]
- 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:[4]
- 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.[5]
- ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
- Gamma-glutamyltransferase (GGT):[6][7]
- 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:[4]
- 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).[3]
- Antinuclear antibody (ANA) may be raised in primary biliary cirrhosis(20-30%).[3]
- Serum immunoglobulins and serum electrophoresis :
- Elevated IgG may revealed acute hepatitis as the underlying disease for jaundice.[8]
- Elevated IgM may revealed primary biliary cirrhosis as the underlying disease for jaundice.[3]
- 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.
- ↑ 3.0 3.1 3.2 3.3 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.
- ↑ 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.