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first line investigations

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The following tests should be performed in patients with asymptomatic elevation of aminotransferase levels:

  • serology for hepatitis C:
    • presence of antibody to the hepatitis C virus indicates chronic hepatitis C

  • serology for hepatitis B surface and core antigens:
    • presence of antibodies to hepatitis B surface and core antigens indicates chronic hepatitis B

  • 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)

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