Can a diagnosis of autoimmune hepatitis be made on bloods alone?

Hi. I had a hepatic episode just over a year ago where my liver function bloods were abnormal for approx 6-8 weeks. I was mildly jaundiced and very itchy. I had a significantly positive ANA and was seen by a gastroenterologist who felt certain that I was displaying a typical picture of autoimmune hepatitis. At the time that I saw her my symptoms had settled and my bloods were back to normal. She was not keen to do a liver biopsy at that stage so just said we would wait for my next episode. In January this year I was ANA negative. At my review in feb, she was still sure that her initial diagnosis was correct and my gp has now coded my notes as autoimmune hepatitis. I am currently applying for critical illness cover and they want to know if I have this condition. Do I need a liver biopsy to confirm or are bloods enough? And if I do need a liver biopsy, surely it will still show if I have autoimmune hepatitis if taken when an asymptomatic? Any clarity on this would be helpful. Thank you.

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  • There is a diagnostic scoring system for autoimmune hepatitis where the patient is 'scored' on a variety of things and if the score totals 17 or more they definitely have it, if they score 12-17 they 'probably' have it, if they score less than 12 they dont have it. The score is taken from the blood markers ALT, AST and ALP or the AST:ALT ratio, your iGg level, your ANA, AMA, and LKM1 levels, you get a plus or minus if you have viral hepatitis, if you take alcohol, or if you are on any medication which is toxic to the liver. Its quite complicated.

    However the recommendation before any treatment starts is to also do a biopsy, to determine the level of damage to the liver from the AIH and what level of medication to put the patient on.

    Just a positive ANA alone isnt a definite diagnosis of autoimmune hepatitis as it can be elevated in a number of autoimmune conditions i.e Lupus, arthritis etc

  • A diagnosis is made on blood results,liver biopsy and clinical presentation,you should see a heptoligist because a biopsy should always be carried out,its the only real way of seeing what condition the liver is in.

  • Thank you both of you for your replies. I have left a message for my consultant to call me to discuss.

  • I was diagnosed 2 months ago I had both blood tests and biopsy when have the biopsy u can say for sure if liver have any damage cirrhosis and what kind excitably it's ur AIH but it costs so sometimes doctors avoid it my opinion

  • I was diagnosed with AIH in April. I was told by my gastroenterologist that a liver biopsy is needed to diagnose the condition. They also had to do the biopsy to assess liver damage, and determine if fibrosis or cirrhosis had developed. I am also on daily medication to prevent another flare up. I would have thought you do need a biopsy to confirm your diagnosis. Hope this helps.

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