Anti Mitochondrial Antibody

Immunity

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Details

Anti-Mitochondrial Antibody (AMA) test detects autoantibodies directed against proteins found in the inner mitochondrial membrane, especially the M2 subtype. It is highly specific for Primary Biliary Cholangitis (PBC), a chronic autoimmune liver disease

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Anti Mitochondrial Antibody Test - Comprehensive Information Guide

Why is it done?
- Test measures the presence of antibodies against mitochondrial antigens in the blood, which are autoantibodies that attack the patient's own mitochondrial structures
- Primary indication: Diagnosis of Primary Biliary Cholangitis (PBC), formerly known as Primary Biliary Cirrhosis
- Ordered when patients present with unexplained jaundice, pruritus, fatigue, or abnormal liver function tests
- Used to evaluate suspected autoimmune liver disease, particularly in middle-aged women
- May be performed during screening for autoimmune conditions or as part of liver disease workup
- Helpful in distinguishing Primary Biliary Cholangitis from other liver conditions such as hepatitis or cirrhosis from other causes
Normal Range
- Negative Result: Less than 1.0 IU/mL or negative/not detected. This is the normal, healthy result indicating no anti-mitochondrial antibodies are present
- Positive Result: 1.0 IU/mL or higher, or reported as positive/reactive. Indicates presence of anti-mitochondrial antibodies
- Borderline/Equivocal: 0.5-1.0 IU/mL. Results in this range may warrant repeat testing or additional investigations
- Units of measurement: IU/mL (International Units per milliliter) or reported as qualitative positive/negative
- Reference ranges may vary slightly between laboratories; always refer to your specific lab's reference range
Interpretation
- Positive AMA Result: Strongly suggestive of Primary Biliary Cholangitis (PBC). Found in 90-95% of PBC patients. High specificity for PBC diagnosis
- Negative AMA Result: Does not necessarily rule out PBC; approximately 5-10% of PBC patients test AMA-negative (AMA-negative PBC). Other diagnoses should be considered if clinical suspicion remains high
- AMA Subtypes: AMA-M2 (anti-PDC-E2) is the most common and clinically significant. Other subtypes (M4, M9) may be present and can provide additional diagnostic information
- Antibody Titers: Higher titers may correlate with disease activity, though titers don't always correlate with disease severity. Serial titers are not typically used for monitoring
- Clinical Context Matters: Result must be interpreted alongside clinical symptoms, liver function tests, imaging studies, and other laboratory findings. AMA alone is not sufficient for diagnosis without clinical correlation
- Factors Affecting Results: Low positive results near cutoff may warrant repeat testing. Cross-reactivity with other autoimmune antibodies is rare but possible. Recent infections or vaccinations typically do not affect results
Associated Organs
- Primary Organ System: Liver and biliary system. Anti-mitochondrial antibodies target mitochondria in bile duct epithelial cells
- Primary Biliary Cholangitis (PBC): Autoimmune disease causing progressive destruction of intrahepatic bile ducts. Predominantly affects middle-aged and older women. Leads to cholestasis, cirrhosis, and eventual liver failure if untreated
- Associated Autoimmune Conditions: Sjögren's syndrome, rheumatoid arthritis, scleroderma, thyroid disease, and other systemic autoimmune disorders commonly co-occur with PBC
- Potential Complications: Cirrhosis, portal hypertension, hepatic encephalopathy, variceal bleeding, hepatorenal syndrome, cholangiocarcinoma risk, osteoporosis, and hepatic osteodystrophy
- Extrahepatic Manifestations: Pruritus (often severe), fatigue, arthralgia, dry eyes/mouth, bone loss, and metabolic complications may develop
Follow-up Tests
- Anti-AMA Subtype Testing (Anti-M2, M4, M9): Further characterizes the immune response and confirms diagnosis. Anti-M2 (PDC-E2) is most specific for PBC
- Liver Function Tests (LFTs): Alkaline phosphatase, gamma-glutamyl transferase (GGT), transaminases (ALT, AST), bilirubin, and albumin to assess liver function and disease severity
- Anti-Smooth Muscle Antibody (ASMA) and Anti-Nuclear Antibody (ANA): Tests for other autoimmune liver diseases and general autoimmune conditions. Help rule out overlap syndromes or alternative diagnoses
- Liver Biopsy: May be performed to confirm diagnosis in AMA-negative patients with clinical suspicion or to assess stage and degree of fibrosis/cirrhosis
- Abdominal Ultrasound or MRI: Imaging to assess for cirrhosis, portal hypertension, hepatomegaly, or cholangiocarcinoma
- Transient Elastography (FibroScan): Non-invasive measurement of liver fibrosis staging and disease progression assessment
- Immunoglobulin M (IgM) Levels: Often elevated in PBC; may be monitored to assess disease activity
- Thyroid Function Tests (TSH, Free T4): Screen for associated thyroid disease, common in PBC patients
- Monitoring Frequency: Newly diagnosed patients typically followed with LFTs every 3-6 months initially, then every 6-12 months based on treatment response and disease stability
Fasting Required?
- No, fasting is NOT required for Anti-Mitochondrial Antibody testing
- Patient Preparation: Patient may eat and drink normally before the test. No special dietary restrictions
- Medications: Take all regular medications as prescribed. Immunosuppressants, corticosteroids, and other medications do not significantly interfere with AMA test results
- Sample Collection: Simple blood draw; serum or plasma sample required. One 5-10 mL tube is typically sufficient
- Timing: Can be performed at any time of day. No specific time-related factors affect accuracy
- Additional Notes: Inform the phlebotomist of anticoagulation therapy if applicable. No recovery period needed after blood draw

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