investigations

Last reviewed 02/2021

Haematology:

  • greatly raised ESR
  • normocytic normochromic anaemia
  • prolonged prothrombin time - in severe disease
  • positive LE cells - in 15% of cases

Biochemistry:

  • raised serum bilirubin
  • raised serum IgG
  • raised serum alpha-fetoproteins - in one third of cases
  • raised serum transaminases - X10
  • alkaline phosphatase - normal or marginally raised
  • reduced albumin - in severe disease

Special tests:

  • antinuclear antibodies - in 80% of cases
  • smooth muscle antibodies - in 70% of cases
  • mitochondrial antibodies - low / absent
  • antibodies to liver and kidney microsomes - may be present, especially in children; carry a poor prognosis
  • HBsAg and anti-HCV negative

Needle biopsy:

  • cellular infiltrate, predominantly lymphocytes and plasma cells, in acinar zone 1 and infiltrating between the hepatocytes
  • little or no fatty change