First line investigations
The following tests should be performed in patients with asymptomatic elevation of aminotransferase levels:
- serology for hepatitis C:
- presence of antibody to the hepatitis C virus indicates chronic hepatitis C
- presence of antibody to the hepatitis C virus indicates chronic hepatitis C
- serology for hepatitis B surface and core antigens:
- presence of antibodies to hepatitis B surface and core antigens indicates chronic hepatitis B
- presence of antibodies to hepatitis B surface and core antigens indicates chronic hepatitis B
- serum iron and total iron binding capacity:
- increased iron load suggests haemochromatosis
- increased iron load suggests haemochromatosis
- serum caeruloplasmin levels:
- decreased levels suggest Wilson's disease
- decreased levels suggest Wilson's disease
- serum protein electrophoresis:
- increase polyclonal immunoglobulin suggests autoimmune hepatitis
- decreased alpha-globulin suggests alpha-1 antitrypsin deficiency
- liver autoimmune serology (especially if female)
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