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HelpTest Code ALDG2 Autoimmune Liver Disease Panel, Serum
Test Down Notes
Effective 11/24/2025: This test is temporarily unavailable due to reagent supply issues. The downtime is expected to be 30-45 days. See test notification here for alternatives.
Ordering Guidance
This test should be used for evaluating patients at-risk for antinuclear antibody-associated systemic autoimmune rheumatic disease.
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1.5 mL Serum
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Useful For
Evaluating patients with suspected autoimmune liver disease, specifically autoimmune hepatitis or primary biliary cholangitis
Evaluating patients with liver disease of unknown etiology
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| AMA | Mitochondrial Ab, M2, S | Yes | Yes |
| NAIFA | Antinuclear Ab, HEp-2 Substrate, S | Yes | Yes |
| SMAS | Smooth Muscle Ab Screen, S | Yes | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SMAT | Smooth Muscle Ab Titer, S | No | No |
Testing Algorithm
If smooth muscle antibody (SMA) screen is positive, then the SMA titer will be performed at an additional charge.
For more information see First-Line Screening for Autoimmune Liver Disease Algorithm.
Method Name
AMA: Enzyme Immunoassay (EIA)
NAIFA, SMAS, SMAT: Indirect Immunofluorescence
Reporting Name
Autoimmune Liver Disease Panel, SSpecimen Type
SerumSpecimen Minimum Volume
Serum: 1.1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 21 days |
| Frozen | 21 days |
Reference Values
MITOCHONDRIAL ANTIBODIES (M2)
Negative: <0.1 Units
Borderline: 0.1-0.3 Units
Weakly positive: 0.4-0.9 Units
Positive: ≥1.0 Units
Reference values apply to all ages.
ANTINUCLEAR ANTIBODIES
Negative: <1:80
SMOOTH MUSCLE ANTIBODIES
Negative
If positive, results are titered.
Reference values apply to all ages.
Interpretation
The presence of smooth muscle antibodies (SMA) or antinuclear antibodies (ANA) is consistent with a diagnosis of chronic autoimmune hepatitis, in patients with clinical or laboratory evidence of hepatocellular damage.
A positive result for antimitochondrial antibodies (AMA) of M2 specificity in the setting of chronic cholestasis after exclusion of other causes of liver disease is highly suggestive of primary biliary cholangitis.
Negative results for SMA, ANA, or AMA does not exclude a diagnosis of an autoimmune liver disease.
This test is not useful for indicating the stage or prognosis of the disease or for monitoring the course of disease.
Clinical Reference
1. Sebode M, Weiler-Normann C, Liwinski T, Schramm C. Autoantibodies in autoimmune liver disease-clinical and diagnostic relevance. Front Immunol. 2018;9:609
2. Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-176
3. Lindor KD, Bowlus CL, Boyer J, Levy C, Mayo M. Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2019;69(1):394-419
4. Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 Practice Guidance and Guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722
5. Mieli-Vergani G, Vergani D, Czaja AJ, et al. Autoimmune hepatitis. Nat Rev Dis Primers. 2018;4:18017
6. Dalekos GN, Gatselis NK. Autoimmune serology testing in clinical practice: An updated roadmap for the diagnosis of autoimmune hepatitis. Eur J Intern Med. 2023;108:9-17
7. Colapietro F, Lleo A, Generali E. Antimitochondrial antibodies: From bench to bedside. Clin Rev Allergy Immunol. 2022;63(2):166-177
8. Zhang Q, Liu Z, Wu S, et al. Meta-analysis of antinuclear antibodies in the diagnosis of antimitochondrial antibody-negative primary biliary cholangitis. Gastroenterol Res Pract. 2019;2019:8959103
9. Dahlqvist G, Gaouar F, Carrat F, et al. Large-scale characterization study of patients with antimitochondrial antibodies but nonestablished primary biliary cholangitis. Hepatology. 2017;65(1):152-163
10. Caines A, Lu M, Wu T, et al. Pre-diagnosis alkaline phosphatase and antimitochondrial antibody positivity vary by race/ethnicity among patients with primary biliary cholangitis. J Gastroenterol Hepatol. 2025;40(9):2209-2218. doi:10.1111/jgh.17035
Day(s) Performed
Monday through Saturday
Report Available
3 to 4 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
See Individual Test IDsCPT Code Information
86381
86039
86015
86015-Titer (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ALDG2 | Autoimmune Liver Disease Panel, S | 94700-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 609515 | Smooth Muscle Ab Screen, S | 26971-2 |
| AMA | Mitochondrial Ab, M2, S | 51715-1 |
| ANAH | Antinuclear Ab, HEp-2 Substrate, S | 59069-5 |
| 1TANA | ANA Titer: | 33253-6 |
| 1PANA | ANA Pattern: | 49311-4 |
| 2TANA | ANA Titer 2: | 33253-6 |
| 2PANA | ANA Pattern 2: | 49311-4 |
| CYTQL | Cytoplasmic Pattern: | 55171-3 |
| LCOM | Lab Comment: | 77202-0 |
Forms
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) with the specimen.