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Second line investigations

Authoring team

The following investigations should be performed in a patient with asymptomatic elevation of aminotransferase levels who remains undiagnosed despite first-line investigations:

  • reverse-transcriptase PCR for hepatitis C virus RNA

  • alpha-1 antitrypsin phenotyping:
    • a ZZ phenotype is diagnostic of a deficiency state

  • antigliadin and antiendomysial serology:
    • presence indicates coeliac disease

  • creatine kinase and aldolase:
    • elevation indicates muscle disease

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