Test Code SMAT Smooth Muscle Antibody Titer, Serum
Specimen Required
Only orderable as part of a reflex. For more information see SMAS / Smooth Muscle Antibody Screen, Serum.
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.8 mL
Collection Instructions: Centrifuge and aliquot serum into plastic vial
Useful For
Antibody titer testing as a part of the evaluation of patients with hepatitis of unknown origin associated with hypergammaglobulinemia and/or abnormal liver enzymes
Testing Algorithm
If the smooth muscle antibody (SMA) screen is equivocal or positive, then the SMA titer will be performed at an additional charge.
Method Name
Only orderable as part of a reflex. For more information see SMAS / Smooth Muscle Antibody Screen, Serum.
Indirect Immunofluorescence
Reporting Name
Smooth Muscle Ab Titer, SSpecimen Type
SerumSpecimen Minimum Volume
0.4 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 21 days | |
Frozen | 21 days |
Reject Due To
Gross hemolysis | Reject |
Gross lipemia | Reject |
Gross icterus | OK |
Heat-Treated | Reject |
Clinical Information
Autoimmune hepatitis (AIH) is a chronic disease resulting from immune-mediated liver injury with varied clinical manifestations (1,2) The precise factors leading to disease initiation and perpetuation are unknown, but likely reflect a combination of genetic predisposition relating to defects in immunological control of autoreactivity, as well as environmental triggers, which precipitate a persistent breakdown in self-tolerance.(2) Initially, patients with AIH may be clinically asymptomatic, and are usually identified only through an incidental finding of abnormal liver function tests.(1-4) At a more advanced stage, patients may manifest with symptoms such as jaundice, pruritus, or ascites, which are secondary to the more extensive liver damage. As implied by the name, AIH has many characteristics of an autoimmune disease, including female predominance, hypergammaglobulinemia, association with specific HLA alleles, responsiveness to immunosuppression, and the presence of autoantibodies.(1-3)
The clinical features of AIH are nonspecific and can be seen in variety of liver diseases (drug/alcohol-associated hepatitis, viral hepatitis, primary sclerosing cholangitis, etc), the diagnosis can be challenging. A set of diagnostic criteria for AIH has been published and includes the presence of various autoantibodies, elevated total IgG, evidence of hepatitis on liver histology, and absence of viral markers.(1,3,4) Based on the specific autoantibodies present, AIH can be categorized in three categories.(4) The most prevalent is AIH type 1, linked to the presence of smooth muscle autoantibodies,(SMA) antinuclear antibodies (ANA) and perinuclear anti-neutrophil cytoplasmic antibodies. SMA are generally identified by indirect immunofluorescence using a smooth muscle substrate. The antigen specificity of SMA in the context of AIH has been identified as filamentous-actin (F-actin).(3) The combination of autoantibody serology, specifically SMA and anti-F-actin antibodies with liver histology and thorough clinical evaluation are useful in the evaluation of patients with suspected autoimmune hepatitis. SMA are detected in up to 85% of patients with AIH, either alone or in conjunction with ANA.(1,4,5) The SMA titer can also contribute to International Autoimmune Hepatitis Group diagnostic score in patients with a probable or definite diagnosis of AIH.(1,4,5) These antibodies have also been reported in 33% to 65% of cases of primary biliary cholangitis/AIH overlap syndrome(6), the concomitant presence of SMA and AMA being highly suggestive in this setting.
Reference Values
Only orderable as part of a reflex. For more information see SMAS / Smooth Muscle Antibody Screen, Serum.
Negative
Reference values apply to all ages.
Interpretation
Positivity for smooth muscle antibodies (SMA) may help support a diagnosis of autoimmune hepatitis (AIH) following exclusion of other causes of hepatitis.
A negative result for SMA does not exclude a diagnosis of AIH.
Specimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in RochesterTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
86015
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
SMAT | Smooth Muscle Ab Titer, S | 5358-7 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
608956 | Smooth Muscle Ab Titer, S | 5358-7 |
Day(s) Performed
Monday through Saturday