HepatitJs T globulins Auto Abs

Classification (NEJM 2006354:54. Coon 2001:1201502)

• Type 1: ano-smooth muscle Ab (ASMA). ANA 3 4 female; t autoimmune thyroiditis, VJC

anti-soluble liver antigen (anti-SLA) associated with more severe disease and relapse

• Type 2: anti-liver kidney microsome type 1 (anti-LKM1); children (age 2-14)

• Diagnosis: combination of autoimmune serologies. T globulin, exclusion of other causes of liver disease, and liver biopsy showing plasma cell infiltrate with interface hepatitis

Overlap syndromes

• Autoimmune hepatitis • primary biliary cirrhosis or primary sclerosing cholangitis Treatment

• Indie.: AST 10x ULN. AST 5x ULN • glob 2x ULN, or bridging multiacinar necrosis

• Prednisone azathioprine 65% remission w in 3 y, 50% relapse on withdrawal of meds at 6 mos; up to 90% by 3 y, most will require long-term Rx

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