Budd-Chiari syndrome laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Budd-Chiari syndrome should be suspected in patients with predisposing conditions such as malignancy or hypercoagulable states. When Budd-Chiari syndrome is suspected, liver function tests and levels of creatinine, urea, electrolytes, LDH should be evlauated. Liver biopsy for the presence of antiphospholipid antibodies is usually tested for patients with primary BCS. Bone marrow biopsy can be used to diagnose associated myeloproliferative disorders, which are common in BCS. Laboratory findings consistent with the diagnosis of acute and fulminant BCS include, elevated serum aspartate aminotransferase and alanine aminotransferase levels (may be more than five times the upper limit of the normal range) and elevated serum alkaline phosphatase and bilirubin levels, decreased serum albumin level. Ascitic fluid examination shows: Total protein more than 2.5 g per deciliter and white blood cells are usually less than 500/μL. Additional hematological tests are recommended to evaluate for hypercoagulability.

• Suspect Budd-Chiari syndrome in patients with predisposing conditions such as malignancy or hypercoagulable states.
• When Budd-Chiari syndrome is suspected, measurements are made of:^[1][2]
  • Liver enzyme levels
  • Electrolytes
  • Serum alkaline phosphatase levels
  • Creatinine
  • Urea
  • Ascitic fluid analysis
  • LDH
  • Liver biopsy is nonspecific but sometimes necessary to differentiate between Budd-Chiari syndrome and other causes of hepatomegaly and ascites, such as galactosemia or Reye’s syndrome.
  • Factor V Leiden and Factor II (prothrombin) mutations, for the presence of antiphospholipid antibodies, is usually tested for patients with primary BCS.
  • Bone marrow biopsy can be used to diagnose associated myeloproliferative disorders are common in BCS.
• Laboratory findings consistent with the diagnosis of acute and fulminant BCS include:
  • Elevated serum aspartate aminotransferase and alanine aminotransferase levels may be more than five times the upper limit of the normal range.
  • Elevated serum alkaline phosphatase and bilirubin levels, decreased serum albumin level.
• Ascitic fluid examination shows:
  • Total protein more than 2.5 g per deciliter
  • White blood cells are usually less than 500/μL.
• Additional Hematological tests are recommended to evaluate for hypercoagulability.