Which lab studies are necessary for the diagnosis of conjugated hyperbilirubinemia?

Updated: Jul 31, 2019
  • Author: Richard A Weisiger, MD, PhD; Chief Editor: BS Anand, MD  more...
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Obtain the following laboratory studies for all patients with suspected conjugated hyperbilirubinemia:

  • Complete blood cell (CBC) count to screen for hemolysis

  • Serum aminotransferases (aspartate aminotransferase [AST], alanine aminotransferase [ALT])

  • Serologic screen for viral hepatitis, including hepatitis C virus (HCV) antibody and hepatitis B surface antigen (HBsAg) or antihepatitis B core antibody (anti-HBcAb)

  • Alkaline phosphatase (ALP): If elevated or if an obstruction is suspected, images of the bile ducts should be obtained. Gamma-glutamyl transpeptidase (GGTP) results may help differentiate a hepatic source of the elevated ALP from bone or other causes.

  • Blood alcohol or acetaminophen levels upon admission (may be useful in certain cases).

  • Antimitochondrial antibody when considering primary biliary cirrhosis

  • Antinuclear antibodies (ANAs), smooth-muscle antibodies, and other serologic studies when considering autoimmune hepatitis

  • Iron and genetic studies when considering hemochromatosis

  • Copper studies when considering Wilson disease

  • Alpha-1 antitrypsin fractionation and other studies when considering hereditary liver diseases

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