Autoimmune hepatitis laboratory findings

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

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.