Table 1.
Work-up for causes of acute liver failure in reported patient
| Laboratory test | Result | Reference range |
| Hepatic function panel | ||
| Aspartate aminotransferase | 624 U/L (H) | 7-36 U/L |
| Alanine aminotransferase | 520 U/L (H) | 4-45 U/L |
| Alkaline phosphatase | 156 U/L (H) | 31-103 U/L |
| Bilirubin, total | 34.7 mg/dL (H) | 0.2-1.1 mg/dL |
| Bilirubin, conjugated | 14.8 mg/dL (H) | 0.0-0.2 mg/dL |
| Albumin | 3.6 g/dL (L) | 3.7-5.1 g/dL |
| Total Protein | 5.8 g/dL (L) | 6.2-8.6 g/dL |
| Coagulation factors | ||
| Prothombin time | 37.9 s (H) | 9.1-11.9 s |
| INR | 3.5 (H) | < 1.2 |
| Factor VII activity | < 6% (L) | > 50% activity |
| Factor V activity | 18% (L) | > 50% activity |
| Tumor markers | ||
| CEA | 2.3 ng/mL | < 3.1 ng/mL |
| CA 19-9 | 235 U/mL (H) | 0-35 U/mL |
| AFP | 51.1 ng/mL (H) | 1.6-4.5 ng/mL |
| AFP-L3 | 19.0% (H) | 0.5%-9.9% |
| PIVKA | 4.4 ng/mL | < 6.3 ng/mL |
| Viral serologies | ||
| Hepatitis A, IgM | Nonreactive | Nonreactive |
| Hepatitis A, IgG | Reactive1 | Nonreactive |
| Hepatitis B surface antigen | Nonreactive | Nonreactive |
| Hepatitis B surface antibody, quantitative | < 10 IU/L | < 10 IU/L |
| Hepatitis B core antibody, total | Nonreactive | Nonreactive |
| Hepatitis C antibody screen | Nonreactive | Nonreactive |
| Hepatitis C RNA quantitative PCR | Not Detected | Not detected |
| Hepatitis E antibody, IgG | Not Detected | Not detected |
| Hepatitis E antibody, IgM | Not Detected | Not detected |
| CMV antibody immune status | Positive1 | Negative |
| CMV DNA quantitative PCR | Not Detected | Not detected |
| Liver tissue CMV in situ hybridization | Negative | Negative |
| EBV-VCA IgM | Negative | Negative |
| EBV-VCA IgG | Positive1 | Negative |
| EBV DNA quantitative PCR | Not Detected | Not detected |
| Liver tissue EBV in situ Hybridization | Negative | Negative |
| Adenovirus DNA Quantitative PCR | Not Detected | Not Detected |
| Liver tissue adenovirus in situ hybridization | Negative | Negative |
| Herpes Simplex 1 IgM screen | Negative | Negative |
| Herpes Simplex 2 IgM screen | Negative | Negative |
| Liver Tissue HSV 1 and 2 in situ hybridization | Negative | Negative |
| RPR | Nonreactive | Nonreactive |
| Autoantibody titer | ||
| Antinuclear antibody | Positive1 | Negative |
| Antinuclear antibody titer | 1:401 | < 1:20 |
| Smooth muscle antibody | < 1:20 | < 1:20 |
| Liver kidney microsome antibody IgG | < 20.0 U | < 20.0 U |
| Soluble liver antigen autoantibody | < 20.1 U | < 20.1 U |
| Wilson’s disease evaluation | ||
| Copper, RBC | 0.71 mg/L | 0.53-0.91 mg/L |
| Copper, serum | 95 μg/dL | 70-140 μg/dL |
| Ceruloplasmin | 22 mg/dL | 17-48 mg/dL |
| Copper, 24-h urine | 1055 μg/d (H) | 3-50 μg/day |
| Quantitative liver copper | 47 μg/g tissue | 10-55 μg/g tissue |
| Hemochromatosis evaluation | ||
| Total iron | 243 μg/dL (H)2 | 23-202 μg/dL |
| Iron binding capacity | < 308 μg/dL (L)3 | 240-520 μg/dL |
| Transferrin | 163 mg/dL (L) | 198-386 mg/dL |
| Ferritin | 3254 ng/mL (H) | 8-350 ng/mL |
| Alpha-1-antitrypsin | 91 mg/dL | 83-199 mg/dL |
| Acetaminophen | < 10 μg/mL | 10-20 μg/mL |
1
Indicates positive result;
2
(H) indicates value above the reference range;
3
(L) indicates value below the reference range. AFP: Alpha-fetoprotein; EBV: Epstein Barr virus; CEA: Carcinoembryonic antigen; CMV: Cytomegalovirus; CA 19-9: Carbohydrate antigen 19-9; AFP-L3: Lectin-reactive AFP percentage; HSV: Herpes simplex virus; INR: International normalized ratio; PCR: Polymerase chain reaction; PIVKA: Protein induced by vitamin K absence.