Cirrhosis

The cirrhosis tests check for signs of liver malfunction, such as excess bilirubin, as well as for certain enzymes that may indicate liver damage. Ulta Lab Tests provides reliable blood work and secure testing, so order today!


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Actin is the major antigen to which smooth muscle antibodies react in autoimmune hepatitis. F-Actin IgG antibodies are found in 52-85% of patients with autoimmune hepatitis (AIH) or chronic active hepatitis and in 22% of patients with primary biliary cirrhosis (PBC). Anti-actin antibodies have been reported in 3-18% of sera from normal healthy controls.


This assay is intended for use in the assessment of risk for the development of hepatocellular carcinoma (HCC) in patients with chronic liver disease.


IMPORTANT - The specimen for this test must be collected at a patient service center that can collect, store and transport frozen samples as outlined below.  

IMPORTANT: Before ordering this lab test, check and confirm with the selected patient service center to ensure that they can collect, store and transport frozen samples as outlined below.

Preferred Specimen(s) 

2 mL frozen plasma collected in an EDTA (lavender-top) tube

Collection Instructions 

Collect blood from stasis-free vein of patient (e.g., no tourniquet). Patient should not clench fist during collection, as muscular exertion often increases venous ammonia levels. Patient should avoid smoking prior to phlebotomy since smoking increases plasma ammonia levels. Tubes should be filled completely and kept tightly stoppered at all times. Place immediately on ice. Separate plasma from cells within 20 minutes and freeze plasma immediately.

Transport Temperature 

Frozen

Specimen Stability 

Room temperature: Unstable
Refrigerated: Unstable
Frozen -20° C: 72 hours
Frozen -70° C: 7 days

Reject Criteria 

Hemolysis • Lipemia • Received thawed • PPT Potassium EDTA (white-top) tube

Clinical Significance

Ammonia is one of the by-products of protein metabolism. Elevated blood ammonia levels have been associated with severe liver dysfunction such as hepatic encephalopathy, coma resulting from cirrhosis, severe hepatitis, Reye's syndrome, and drug hepatotoxicity. Also, elevated blood ammonia has been reported in cardiac failure, azotemia, and pulmonary emphysema. Correlation between plasma ammonia and the degree of encephalopathy can be erratic.


AST is widely distributed throughout the tissues with significant amounts being in the heart and liver. Lesser amounts are found in skeletal muscles, kidneys, pancreas, spleen, lungs, and brain. Injury to these tissues results in the release of the AST enzyme to general circulation. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peak within two days and return to normal by the fourth or fifth day post infarction. An increase in serum AST is also found with hepatitis, liver necrosis, cirrhosis, and liver metastasis.

BNP is increased in congestive heart failure, left ventricular hypertrophy, acute myocardial infarction, coronary angioplasty, and hypertension. Elevations are also observed in pulmonary hypertension (indicating right ventricular dysfunction), acute lung injury, hypervolemic states, chronic renal failure and cirrhosis. Decreasing levels indicate therapeutic response to anti-hypertensive therapy.

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Decreased levels of ceruloplasmin are found in Wilson''s Disease, fulminant liver failure, intestinal malabsorption, renal failure resulting in proteinuria, chronic active hepatitis and malnutrition. Elevated levels are found in primary biliary cirrhosis, pregnancy (first trimester), oral contraceptive use and in acute inflammatory conditions since ceruloplasmin is an acute phase reactant

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)


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Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions and during the third trimester of pregnancy. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Urinary copper concentrations are also useful to monitor patients on chealation therapy

Clinical Significance

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Copper concentrations increase in acute phase reactions. Copper concentrations are decreased with nephrosis, malabsorption, and malnutrition. Copper concentrations are also useful to monitor patients, especially preterm newborns, on nutritional supplementation. Results of copper are often interpreted together with ceruloplasmin.


The DCP assay is intended for in vitro diagnostic use as an aid in the risk assessment of patients with chronic liver disease for progression to hepatocellular carcinoma (HCC) in conjunction with other laboratory findings and clinical assessment.

Elevated GGT is found in all forms of liver disease. Measurement of GGT is used in the diagnosis and treatment of alcoholic cirrhosis, as well as primary and secondary liver tumors. It is more sensitive than alkaline phosphatase, the transaminases, and leucine aminopeptidase in detecting obstructive jaundice, cholangitis, and cholecystitis. Normal levels of GGT are seen in skeletal diseases; thus, GGT in serum can be used to ascertain whether a disease, suggested by elevated alkaline phosphatase, is skeletal or hepatobiliary.

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Immunoglobulin A (IgA)

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Clinical Use

  • Diagnose IgA deficiencies

  • Determine etiology of recurrent infections

  • Diagnose infection

  • Diagnose inflammation

  • Diagnose IgA monoclonal gammopathy

Clinical Background

IgA is the first line of defense for the majority of infections at mucosal surfaces and consists of 2 subclasses. IgA1 is the dominant subclass, accounting for 80% to 90% of total serum IgA and greater than half of the IgA in secretions such as milk, saliva, and tears. IgA2, on the other hand, is more concentrated in secretions than in blood. IgA2 is more resistant to proteolytic cleavage and may be more functionally active than IgA1.

IgA deficiency is the most prevalent isotype deficiency, occurring in 1/400 to 1/700 individuals. Many patients with IgA deficiency are asymptomatic, while others may develop allergic disease, repeated sinopulmonary or gastroenterologic infections, and/or autoimmune disease. Individuals with complete absence of IgA (<5 mg/dL) may develop autoantibodies to IgA after blood or intravenous immunoglobulin infusions and may experience anaphylaxis on repeat exposure. 

Elevated serum IgA levels are associated with infection, inflammation, or IgA monoclonal gammopathy.

 

Serum iron quantification is useful in confirming the diagnosis of iron-deficiency anemia or hemochromatosis. The measurement of total iron binding in the same specimen may facilitate the clinician''s ability to distinguish between low serum iron levels caused by iron deficiency from those related to inflammatory neoplastic disorders. The assay for iron measures the amount of iron which is bound to transferrin. The total iron binding capacity (TIBC) measures the amount of iron that would appear in blood if all the transferrin were saturated with iron. It is an indirect measurement of transferri

Clinical Significance

Liver Fibrosis, FibroTest-ActiTest Panel - FibroTest and ActiTest permit the non-invasive evaluation of Hepatitis C (or B) individuals for the presence of liver fibrosis and liver inflammation, respectively. The FibroTest and ActiTest scores are calculated based on patient age, gender and concentrations of serum of y-glutamyl transferase (GGT), total bilirubin (TB), a-2 macroglobulin, haptoglobin, apolipoprotein A1 and alanine aminotransferase (ActiTest). Fibrotest and ActiTest Scores, on a scale of 0.0 to 1.0, are assigned a Metavir scale indicating the level of fibrosis or inflammation present.

Includes

  • Fibrosis Score, Fibrosis Stage, Fibrosis Interpretation
  • Necroinflammat Act Score, Necroinflammat Act Grade, Necroinflammat Interpretation
  • Alpha-2-Macroglobulin
  • Haptoglobin
  • Apolipoprotein A1
  • Total Bilirubin
  • GGT
  • ALT

Patient Preparation

Overnight fasting is preferred


The presence of LKM-1 antibodies can be used in conjunction with clinical findings and other laboratory tests to aid in the diagnosis of autoimmune liver diseases such as autoimmune hepatitis (AIH-2).


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A high Anti-Mitochondrial Antibody (AMA) titer supports the diagnosis of primary biliary cirrhosis (PBC). Low titers of AMA may be detected in other liver disorders, which include chronic active hepatitis and cryptogenic cirrhosis. Mitochondrial M2 Antibody has an even higher specificity for PBC.

If Mitochondrial Antibody Screen is positive, Mitochondrial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).


Primary Biliary Cirrhosis Diagnostic Panel 9 (REFLUX TEST) Includes

ANA Screen, IFA, with Reflex to Titer and Pattern; Sjögren's Antibodies (SS-A, SS-B); Mitochondrial Antibody with Reflex to Titer; Actin (Smooth Muscle) Antibody (IgG); Thyroid Peroxidase Antibody (Anti-TPO); Liver Kidney Microsome (LKM-1) Antibody (IgG)

NOTE THIS IS A REFLUX TEST

If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
If Mitochondrial Antibody Screen is positive, then Mitochondrial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).


Screening test for abnormalities of coagulation factors that are involved in the extrinsic pathway. Also used to monitor effects of Warfarin therapy and to study patients with hereditary and acquired clotting disorders.

Testosterone, dihydrotestosterone and estrogens circulate in serum bound to Sex Hormone Binding Globulin (SHBG). SHBG concentrations are increased in pregnancy, hyperthyroidism, cirrhosis, oral estrogen administration and by certain drugs. Concentrations are decreased by testosterone, hypothyroidism, Cushings syndrome, acromegaly and obesity


Cirrhosis occurs when healthy liver tissue gets damaged over a long period of time. Chronic liver disease leads to scarring of liver tissue, which affects the structure and functionality of the liver. Cirrhosis is linked to over 32,000 annual deaths in the United States alone.  

A wide variety of chronic liver conditions could be responsible for cirrhosis. It takes years or even decades to develop the condition. Compared to scars that occur in most of the other parts of the body, liver scarring is reversible – even in patients with cirrhosis. The liver is located on the upper right-hand side of your abdomen and is a vital organ in the body. It converts nutrients from food into vital blood components, metabolizes, detoxifies, and produces many factors that are necessary for blood clotting. The liver also produces bile for the digestion of fats. 

Liver disease can affect all these functions. Liver disease can occur due to a wide variety of causes such as physical injuries, infections, autoimmune conditions, exposure to toxins, and genetic conditions that lead to the build-up of iron and copper. Liver disease can lead to inflammation, clotting abnormalities, obstruction of bile flow, and many other conditions. Persistent or prolonged damage to the liver results in accumulating excess connective tissue or fibrosis of the liver – which can lead to cirrhosis at a later stage.  

When one has cirrhosis, the structure of his/her liver will change – forming nodules of cells that are surrounded by fibrous tissue. Fibrous tissue won’t function like healthy liver tissue. It will interfere with the flow of bile and blood through the liver. Cirrhosis begins to affect many other organs and tissues throughout the body as the condition progresses. Some examples of cirrhosis complications include: 

  • Portal Hypertension – The pressure increases in the vein that carries blood to the liver.  
  • Swelling and bleeding of veins in the esophagus or stomach – this happens because of the increased pressure due to portal hypertension and the redirection of blood into the smaller veins. 
  • Increasing of blood toxins – which can lead to confusion and many other mental changes. 
  • Kidney disfunction 
  • Fluid build-up in the abdomen – Ascites 
  • Easy bleeding and bruising due to the decline in the production of clotting factor. 
  • Patients who suffer from cirrhosis are at a higher risk of developing liver cancer over time – about 3-5% of cirrhosis patients are supposed to get multiple cancers, including liver cancer in the long run. 

Causes:

When injury or damage to the liver is limited, it can repair itself. But when injury or damage is repeated over many years, it will result in liver cirrhosis.

There are many causes of liver cirrhosis, but they fall into one of these categories: 

  • Excessive use of alcohol over time can lead to alcoholic liver cirrhosis in the long run. 
  • Hepatitis conditions such as viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and autoimmune hepatitis 
  • Damage to bile ducts or biliary obstruction 
  • Congestive heart failure can result in liver damage and cirrhosis in the long run. 
  • Drug and toxin-related conditions 
  • Metabolic or inherited conditions such as hemochromatosis, cystic fibrosis, and Wilson disease 
  • In about 10% of cirrhosis cases, the actual cause is unknown. 

The causes of liver cirrhosis may vary by population or geographic region. Over 50% of the cases in the United States are caused due to alcoholism or chronic hepatitis C infection. Chronic hepatitis B infection coupled with hepatitis D co-infection leads to a significant number of cirrhosis cases in other parts of the world. Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) are two of the most common causes of non-infectious cirrhosis. The frequency of this cause is increasing across the globe. 

Symptoms of Liver Cirrhosis 

Most people who suffer from the condition don’t have or have little clinical evidence of the disease. Symptoms don’t usually occur until significant scarring of the liver has occurred. Some of the symptoms of the condition include: 

  • Weakness 
  • Fatigue 
  • Confusion and difficulty in concentrating 
  • Itching 
  • Abdominal discomfort 
  • Jaundice 
  • Abdominal swelling due to ascites or build-up of fluid in the abdomen 
  • Leg swelling 
  • Easy bruising and bleeding 
  • Nausea 
  • Loss of appetite and weight loss 

Tests 

Cirrhosis needs to be diagnosed as soon as possible to have a chance of saving the life of the patient. If not, significant liver damage could occur with little or no clinical evidence of the condition. When the cause of the liver disease is controlled or eliminated, the scarring will stop, and some existing scars may resolve. There isn’t a specific test to diagnose liver cirrhosis. But blood tests can help detect liver injury. A liver biopsy is the best test to diagnose cirrhosis. But the procedure is invasive and won’t detect every case. 

Routine laboratory tests can help detect liver damage or scarring. These tests can help evaluate the severity of the condition in case the patient has some risk factors of developing cirrhosis. The patient may need additional tests to diagnose the underlying cause of the condition and monitor his or her health in the long run. It includes monitoring the development of hepatocellular carcinoma. 

Routine Tests 

Liver injury is usually diagnosed by a liver panel or a comprehensive metabolic panel (CMP).

Here are some tests included in these panels: 

  • Aspartate aminotransferase (AST) – AST is an enzyme found in the liver and many other organs in the body. AST will be elevated if a person has a liver injury or cirrhosis. 
  • Alanine aminotransferase (ALT) – This enzyme is found mainly in the liver. The values will be increased when a person has a liver disease or cirrhosis. 
  • Alkaline phosphatase (ALP) – ALP is an enzyme found in the bile ducts. When one has cirrhosis, ALP can be normal or mildly elevated.  
  • Total bilirubin – Bilirubin is produced exclusively in the liver. It increases with most liver conditions. Bilirubin is either normal or slightly increased until cirrhosis becomes advanced. 
  • Albumin – This is a protein made by the liver and decreases when one has cirrhosis. 

If any of these test results are abnormal, one needs to further investigate the cause of it. The pattern of results will be more informative than any single test. 

Complete Blood Count or CBC – This test is ordered to evaluate the red and white blood cells and platelets. Anemia can occur if bleeding has occurred. Platelets become decreased when one has cirrhosis. 

Prothrombin Time (PT/INR) – Most of the clotting factors are produced in the liver. This test is important to evaluate the clotting function. The results can be prolonged with cirrhosis. 

These tests are used to monitor the progression of cirrhosis. As the condition progresses, the results can become increasingly abnormal.  

Additional Testing 

If a patient has chronic liver disease, the healthcare provider will order hepatitis C and B testing to determine the underlying cause of the condition. If ascites is present, your healthcare provider will order a peritoneal fluid analysis test. A liver biopsy is done to diagnose the cause of the condition. It involves taking a sample of liver tissue to evaluate the structure and cells of the liver. A biopsy will clearly indicate the presence of cirrhosis. But since the sample is tiny, a negative result cannot rule out cirrhosis. Depending on the situation, one or more of these specialized tests may be performed: