Test Catalog

Test ID: ALDG    
Autoimmune Liver Disease Panel, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluation of patients with suspected autoimmune liver disease, specifically autoimmune hepatitis or primary biliary cirrhosis


Evaluation of patients with liver disease of unknown etiology

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If smooth muscle antibody (SMA) screen is positive then the SMA titer will be performed at an additional charge.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Autoimmune liver diseases result from damage to hepatocytes or cholangiocytes caused by an inflammatory immune reaction. Included within this disease group are autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). In some cases, patients with these diseases may present asymptomatically, with increases in various liver enzymes being identified incidentally during an unrelated clinical evaluation. On the other end of the spectrum are patients who present with clinical evidence of liver disease, including fatigue, hepatomegaly, ascites, esophageal varices, and jaundice.


Diagnosis of an autoimmune liver disease first requires that other etiologies of liver injury, including viral, drug, and metabolic causes, be excluded. In some situations, a liver biopsy may be indicated. For those patients in whom an autoimmune liver disease is suspected, autoantibody serology testing may be considered. This assay includes markers that may support a diagnosis of an autoimmune liver disease, specifically AIH or PBC. Unfortunately, there are no known autoantibodies specific for PSC that are useful as diagnostic markers.


Patients with AIH may be positive for smooth muscle antibodies (SMA) and/or antinuclear antibodies (ANA). The SMA associated with AIH are generally specific for F-actin. SMA have a specificity of 80% to 90% for AIH, although the sensitivity is only in the range of 70% to 80%. In contrast, ANA, although relatively sensitive for AIH, lack specificity, being associated with a variety of autoimmune diseases. Both SMA and ANA, along with other lab markers and biopsy evaluation, are included in the international diagnostic criteria for AIH.


Antimitochondrial antibodies (AMA) are a diagnostic marker for PBC. AMA are found in more than 90% of patients with PBC, with a specificity of greater than 95%. AMA are included in the diagnostic criteria for PBC, which were developed through an international collaborative effort.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.



If positive, results are titered.

Reference values apply to all ages.



Negative: <0.1 Units

Borderline: 0.1-0.3 Units

Weakly positive: 0.4-0.9 Units

Positive: > or =1.0 Units

Reference values apply to all ages.



Negative: < or =1.0 Units

Weakly positive: 1.1-2.9 Units

Positive: 3.0-5.9 Units

Strongly positive: > or =6.0 Units

Reference values apply to all ages.

Interpretation Provides information to assist in interpretation of the test results

The presence of smooth muscle antibodies (SMA) or antinuclear antibodies (ANA) is consistent with a diagnosis of chronic autoimmune hepatitis, in patients with clinical or laboratory evidence of hepatocellular damage.


The presence of antimitochondrial antibodies (AMA) is consistent with a diagnosis of primary biliary cirrhosis, in patients with clinical or laboratory evidence of hepatobiliary damage.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Smooth muscle antibodies (SMA) may be found in patients with active hepatitis caused by alcohol or drug exposure.


Antinuclear antibodies (ANA) occur in patients with a variety of systemic autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, Sjogren syndrome, and systemic sclerosis.


The presence of smooth muscle antibodies (SMA), antinuclear antibodies (ANA), and antimitochondrial antibodies (AMA) should not be exclusively relied upon to diagnose an autoimmune liver disease. Correlation with clinical presentation and other laboratory parameters of liver disease is required.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Invernizzi P, Lleo A, Podda M: Interpreting serological tests in diagnosing autoimmune liver diseases. Sem Liver Dis. 2007;27(2):161-172

2. Hennes EM, Zeniya M, Czaja AJ, et al: Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatol. 2008;48:169-176

3. Muratori L, Granito A, Muratori P, et al: Antimitochondrial antibodies and other antibodies in primary biliary cirrhosis: diagnostic and prognostic value. Clin Liver Dis. 2008;12:261-276

4. Karlsen TH, Schrumpf E, Boberg KM: Update on primary sclerosing cholangitis. Dig Liver Dis. 2010;42:390-400