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Anti-Smooth Muscle Antibody

Immunity
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Report in 24Hrs

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No Fasting Required

Details

They are particularly associated with autoimmune hepatitis, but can also be seen in other autoimmune and liver-related diseases.

₹2,030₹2,650

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Anti-Smooth Muscle Antibody Test Information Guide

  • Why is it done?
    • Detects autoantibodies against smooth muscle proteins, primarily actin, which are markers of autoimmune liver disease
    • Diagnosis of autoimmune hepatitis (AIH), particularly Type 1 AIH, where ASMA is a hallmark serological marker
    • Evaluation of chronic liver disease with elevated liver enzymes and unknown etiology
    • Assessment of patients with hepatitis presenting with autoimmune features or lack of viral markers
    • Monitoring disease activity and response to immunosuppressive therapy in diagnosed autoimmune hepatitis
    • Investigation of overlap syndromes combining features of autoimmune hepatitis with other autoimmune liver diseases
    • Typically ordered in patients presenting with signs of liver disease, including elevated transaminases, elevated bilirubin, and clinical symptoms such as fatigue, jaundice, or abdominal discomfort
  • Normal Range
    • Normal Result: Negative or <1:40 titer (by indirect immunofluorescence) or <1 IU/mL (by ELISA methods)
    • Borderline Result: 1:40 to 1:80 titer or equivocal by ELISA; may require repeat testing or clinical correlation
    • Positive Result: ≥1:80 titer (by indirect immunofluorescence) or ≥1 IU/mL (by ELISA); clinically significant
    • High Positive Result: ≥1:160 titer or significantly elevated by ELISA; highly suggestive of autoimmune hepatitis
    • Units of Measurement: Titer (serum dilution) for indirect immunofluorescence or International Units per milliliter (IU/mL) for ELISA
    • Clinical Interpretation: Negative results help exclude autoimmune hepatitis; positive results support diagnosis when combined with clinical and biochemical findings; higher titers correlate with increased likelihood of autoimmune liver disease
  • Interpretation
    • Negative Result (Negative or <1:40): Does not support diagnosis of autoimmune hepatitis; other causes of liver disease should be investigated including viral hepatitis, alcohol-related liver disease, metabolic disorders, or cholestatic diseases
    • Low Positive Result (1:40-1:80): Suggestive of autoimmune hepatitis but must be interpreted with clinical context; may indicate early disease, inactive disease, or require confirmation with repeat testing; correlation with liver biopsy findings, immunoglobulin levels, and other autoantibodies is essential
    • Moderate to High Positive Result (≥1:80): Strongly indicative of autoimmune hepatitis, especially when combined with elevated liver enzymes (ALT/AST), elevated immunoglobulin G levels, and characteristic histology; diagnostic criterion for Type 1 autoimmune hepatitis
    • Very High Titers (≥1:160): Highly specific for autoimmune hepatitis; associated with more active disease and greater likelihood of progressive liver fibrosis; usually requires immunosuppressive therapy
    • Factors Affecting Results: Time in disease course (earlier detection has lower titers), current immunosuppressive therapy (may lower titers), sample handling and storage, laboratory methodology differences, presence of other autoantibodies, concurrent infections, and malignancy
    • Clinical Significance of Patterns: ASMA alone is part of Type 1 AIH diagnosis; when combined with anti-nuclear antibody (ANA), supports classical autoimmune hepatitis; presence with anti-mitochondrial antibody (AMA) suggests overlap syndrome; persistently negative ASMA despite clinical features may indicate Type 2 AIH (anti-LKM positive) or other liver pathology
  • Associated Organs
    • Primary Organ System: Hepatic system (liver); smooth muscle antibodies target hepatic myofibroblasts and portal myofibroblasts
    • Autoimmune Hepatitis (Type 1 AIH): Primary disease associated with ASMA positivity; autoimmune attack on hepatocytes leading to chronic hepatitis; ASMA present in 50-90% of Type 1 AIH cases
    • Primary Biliary Cholangitis (PBC): ASMA may be present in PBC/autoimmune hepatitis overlap syndrome; indicates more aggressive disease course
    • Primary Sclerosing Cholangitis (PSC): Can present with ASMA positivity when combined with autoimmune hepatitis features; affects bile ducts and liver
    • Complications of Abnormal Results: Progressive hepatic fibrosis and cirrhosis development; liver failure; hepatic encephalopathy; portal hypertension and esophageal varices; increased risk of hepatocellular carcinoma; liver transplantation necessity
    • Extra-Hepatic Manifestations: Autoimmune hepatitis may present with systemic manifestations including arthralgia, arthritis, fatigue, thyroiditis, celiac disease, and other autoimmune conditions
  • Follow-up Tests
    • Complementary Autoantibody Testing: Anti-nuclear antibody (ANA) to confirm Type 1 AIH diagnosis; anti-LKM-1 (anti-liver-kidney microsomal) to distinguish Type 2 AIH; anti-mitochondrial antibody (AMA) and anti-centromere antibody (ACA) for PBC overlap; anti-soluble liver antigen (anti-SLA/LP) for additional autoimmune hepatitis confirmation
    • Liver Biochemistry Panel: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, gamma-glutamyl transferase (GGT), total and direct bilirubin; repeat testing at 2-4 weeks and then periodically to monitor disease activity and response to therapy
    • Immunoglobulin G (IgG) Quantification: Elevated in autoimmune hepatitis; useful for diagnosis and monitoring; repeat every 3-6 months during treatment
    • Liver Biopsy: Gold standard for confirming autoimmune hepatitis diagnosis; assesses degree of inflammation and fibrosis staging; helps exclude other liver pathology; recommended at initial diagnosis and may be repeated to assess response to therapy
    • Viral Hepatitis Serology: Hepatitis A, B, and C testing to exclude viral causes; important for initial evaluation and to rule out concurrent viral infection
    • Imaging Studies: Ultrasound or computed tomography (CT) for assessment of liver size, echotexture, and signs of cirrhosis; elastography to assess liver fibrosis; screening for hepatocellular carcinoma if cirrhosis present
    • Coagulation Studies: Prothrombin time (PT), International Normalized Ratio (INR), and platelet count to assess hepatic synthetic function and degree of cirrhosis
    • Fibrosis Markers: Non-invasive fibrosis markers such as FibroTest, hyaluronic acid, and procollagen III peptide to assess degree of liver fibrosis; repeat testing to monitor progression
    • Monitoring Frequency: Initial diagnosis requires baseline testing and biopsy; during treatment initiation, biochemistry monitored every 2-4 weeks until stable, then every 3-6 months; long-term monitoring every 6-12 months for stable patients; more frequent if disease activity remains
    • ASMA Repeat Testing: Not routinely repeated if initially positive and diagnosis confirmed; may be repeated if initial result borderline or diagnosis uncertain; rising titer may indicate disease flare but clinical judgment and biochemical changes more informative than titer alone
  • Fasting Required?
    • Fasting Requirement: No - fasting is not required for the anti-smooth muscle antibody test itself
    • Note on Associated Tests: If ASMA is ordered as part of a comprehensive liver disease evaluation panel that includes lipid studies or glucose testing, fasting may be required for those specific tests; always check with your healthcare provider or laboratory for their specific protocols
    • Sample Collection: Blood sample via venipuncture; standard collection into serum separator tube; no special handling required; specimen stable at room temperature for several days or refrigerated for longer storage
    • Medications: No medications need to be avoided specifically for this test; however, immunosuppressive therapy (corticosteroids, azathioprine, mycophenolate) used to treat autoimmune hepatitis may affect ASMA titers and should be noted; continue all regular medications unless otherwise instructed
    • Patient Preparation: Wear loose-fitting clothing to facilitate blood draw; stay hydrated before collection; no special diet restrictions; may be drawn at any time of day; inform phlebotomist of any recent vaccinations or illness as these may theoretically affect autoimmune markers
    • Test Timing: Can be performed at any time; results typically available within 1-5 business days depending on laboratory; rush processing may be available if clinically urgent

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