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
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 , but 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), or 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, or 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, PBC
- 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, haemolytic 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 (over x 3 normal) 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 PBC.(90-95% of patients )[2]
- Antinuclear antibody (ANA) may be rise in PBC.(20-30%)[2]
- Serum immunoglobulins and serum electrophoresis :
- Elevated IgG may revealed acute hepatitis as the underlying disease for jaundice.
- Elevated IgM may revealed PBC as the underlying disease for jaundice.[2]
- Alpha-1-antitrypsin levels:
- Decrease alpha-1-antitrypsin may revealed cirrhosis as the underlying disease for jaundice.
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.