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
    
    
• serology for hepatitis B surface and core antigens:
  • 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
    
    
• serum caeruloplasmin levels:
  • 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)