LFTs in Wilson disease

Q: In acute liver failure (ALF) due to Wilson disease, the ratio of alkaline phosphatase (AP) to total bilirubin (TB) is usually? - select one

A) > 4

B) < 4

      

Answer: B

      

The most crucial thing in Wilson's disease is to rule out other causes of ALF, such as viral hepatitis, alcohol disorder, autoimmune hepatitis, drug-induced liver injury, hereditary hemochromatosis, and alpha-1 antitrypsin deficiency. 

In this regard, a liver function test (LFT) can provide significant clues to establish ALF secondary to Wilson disease. The serum aminotransferases are usually less than 2000 international units/L, and the alkaline phosphatase level is typically normal or below the normal range. In this regard, two of the following ratios can be very helpful.

      

1. AST/ALT ratio of >2 

2. AP/TB ratio < 4

                  

Additionally, low ceruloplasmin is of great significance.

                  

#hepatology

#laboratory-medicine

                  

References:

                  

1. Korman JD, Volenberg I, Balko J, et al. Screening for Wilson disease in acute liver failure: a comparison of currently available diagnostic tests. Hepatology 2008; 48:1167.

                  

2. Alkhouri N, Gonzalez-Peralta RP, Medici V. Wilson disease: a summary of the updated AASLD Practice Guidance. Hepatol Commun. 2023 May 15;7(6):e0150. doi: 10.1097/HC9.0000000000000150. PMID: 37184530; PMCID: PMC10187853.

                  

3. Mazhar A, Piper MS. Updates on Wilson disease. Clin Liver Dis (Hoboken). 2023 Oct 2;22(4):117-121. doi: 10.1097/CLD.0000000000000079. PMID: 37908869; PMCID: PMC10615495.