Anti-smooth muscle antibody
Anti-smooth muscle antibody is a blood test that detects the presence of antibodies against smooth muscle. The antibody is useful in making a diagnosis of autoimmune hepatitis.
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
The 3 types of muscle tissue are cardiac, smooth, and skeletal. Cardiac muscle cells are located in the walls of the heart, appear striated, and are under involuntary control. Smooth muscle fibers are located in walls of hollow visceral organs, except the heart, appear spindle-shaped, and are also under involuntary control. Skeletal muscle fibers occur in muscles which are attached to the skeleton. They are striated in appearance and are under voluntary control.
How the Test is Performed
A blood sample is needed. This may be taken through a vein. The procedure is called a venipuncture.
How to Prepare for the Test
No special steps are needed to prepare for this test.
How the Test will Feel
When the needle is inserted to draw blood, some people feel moderate pain. Others may feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test is Performed
You may need this test if you have signs of certain liver diseases, such as hepatitis and cirrhosis. These conditions can trigger the body to form antibodies against smooth muscle.
Anti-smooth muscle antibodies are not often seen in diseases other than autoimmune hepatitis. Therefore, it is helpful to make the diagnosis. Autoimmune hepatitis is treated with immunosuppressive medicines. People with autoimmune hepatitis often have other autoantibodies. These include:
- Antinuclear antibodies.
- Anti-actin antibodies.
- Anti-soluble liver antigen/liver pancreas (anti-SLA/LP) antibodies.
- Other antibodies may be present, even when the anti-smooth muscle antibodies are absent.
The diagnosis and management of autoimmune hepatitis may require a liver biopsy.
Normal Results
Normally, there are no antibodies present.
Note: Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.
What Abnormal Results Mean
A positive test may be due to:
- Chronic active autoimmune hepatitis
- Cirrhosis
- Infectious mononucleosis
The test also helps distinguish autoimmune hepatitis from systemic lupus erythematosus.
Risks
References
American College of Rheumatology website. Antinuclear antibodies (ANA).
Czaja AJ. Autoimmune hepatitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 90.
Peng SL. Anti-nuclear antibodies. In: Firestein GS, McInnes IB, Koretzky GA, Mikuls TR, Neogi T, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 55.
von Mühlen CA, Chan EKL, Ceribelli A, Fritzler MJ. Clinical and laboratory evaluation of systemic autoimmune rheumatic diseases. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 53.
Version Info
Last reviewed on: 1/28/2025
Reviewed by: Diane M. Horowitz, MD, Rheumatology and Internal Medicine, Northwell Health, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
