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If repeated ALT < 80 IU/L

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Repeat LFTS after a further 3 months

  • if normal then no further action is indicated
  • if ALT > 120 IU/L then refer

  • if ALT not resolving
    • repeat LFTs after further 3 months with further blood tests and liver ultrasound:

First line blood tests (2):

  • serology for hepatitis B and C
  • 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)

 

Consider second line blood tests (2):

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

 

  • if blood tests normal then no further action is required
    • if ALT > 80 refer
    • if ALT raised but < 80 IU/L then repeat LFTs at 12 months to ensure that not rising

Reference:

  1. Pulse (2004); 64 (30):34-6.
  2. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. NEJM 2000;342:1266-71

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