Table 2. Summary of clinical and laboratory features of WD and conditions in its differential diagnosis.

Disease	Clinical laboratory features
Wilson Disease	• Low serum ceruloplasmin (<0.1 g/L)
	• High urinary copper (>40 μg/day or >0.6 μmol/day)
	• Elevated transaminases (often AST > ALT)
	• Hemolytic anemia
Non-Alcoholic Fatty Liver Disease	• ALT or AST are elevated only mildly to moderately in the range of a two- to fivefold elevation
	• Alkaline phosphatase may be abnormally elevated two- to threefold, in fewer than half of patients
Alcohol-Associated Liver Disease	• Typically have moderately elevated aminotransferases (<500 IU/mL) with AST:ALT ratio of two or greater
	• Elevated serum bilirubin (greater than 5 mg/dL)
	• Gamma-glutamyl transferase (GGT) is often elevated
	• Anemia with an elevated mean corpuscular volume (MCV)
	• Elevated serum iron indices (ferritin and transferrin saturation) and hepatic iron
	• IgA levels are increased in chronic ALD. An increased ratio of IgA to IgG is highly suggestive of ALD
Autoimmune Hepatitis	• Acute: Elevations in ALT and AST levels may exceed 10 to 20 times the upper limit of the reference range, and the ratio of alkaline phosphatase to AST (or ALT) is often <1:5, and in some cases is <1:10
	• Chronic or with cirrhosis: AST and ALT elevations are less profound, while the ratio of alkaline phosphatase to AST (or ALT) is lower and approaches 1:2
	• ANA titers in the range of 1:80 to 1:100 or greater are regarded as positive in adults
	• Anti-smooth muscle antibodies (ASMA) are more specific than ANA for autoimmune hepatitis, particularly when present in titers of 1:80 or more

AST, aspartate transaminase; ALT, alanine transaminase; ALD, alcoholic liver disease.