Sign in →

Test ID: A1AFS Alpha-1-Antitrypsin Clearance, Feces and Serum

Ordering Guidance

The recommended procedure for protein-losing enteropathy is A1AFS / Alpha-1-Antitrypsin Clearance, Feces and Serum.

Shipping Instructions

Feces and serum should be shipped together. Specimens shipped separately may delay testing.

Specimen Required

Both feces and serum are required.


Blood must be drawn during the stool collection period.


Specimen Type: Serum

Collection Container/Tube: Red top or serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Centrifuge within 2 hours.

2. Aliquot and ship in plastic vial.


Specimen Type: Feces

Supplies: Stool Containers - 24, 48, 72 Hour Kit (T291)

Container/Tube: Stool container

Specimen Volume: Entire collection

Collection Instructions:

1. Collect a 24-hour fecal collection.

2. If no specimen is obtained within 24 hours, extend collection time to 48 to 72 hours. Document time frame.

Useful For

Diagnosing protein-losing enteropathies

Profile Information

Test ID Reporting Name Available Separately Always Performed
AATS Alpha-1-Antitrypsin, S No Yes
A1ATF Alpha-1-Antitrypsin, 24 Hr, F No Yes

Method Name


Reporting Name

Alpha-1-Antitrypsin Clearance

Specimen Type


Specimen Minimum Volume

Homogenized feces: 1 mL
Serum: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Fecal Frozen (preferred) 14 days
  Ambient  14 days
  Refrigerated  14 days
Serum Frozen (preferred) 28 days
  Ambient  28 days
  Refrigerated  28 days

Clinical Information

Alpha-1-antitrypsin (AAT) is a 54kDa glycoprotein that is resistant to degradation by digestive enzymes and is, therefore, used as an endogenous marker for the presence of blood proteins in the intestinal tract. AAT clearance is reliable for measuring protein loss distal to the pylorus. A serum sample is required to interpret results as a serum deficiency of AAT would make the AAT fecal excretion lower and could invalidate the test utility.


Gastrointestinal protein enteropathy has been associated with regional enteritis, sprue, Whipple intestinal lipodystrophy, gastric carcinoma, allergic gastroenteropathy, intestinal lymphangiectasia, constrictive pericarditis, congenital hypogammaglobulinemia, and iron deficiency anemia associated with intolerance to cow's milk. Increased fecal excretion of AAT can be found in small and large intestine disease and is applicable to adult and children.

Reference Values


≤27 mL/24 hours



≤54 mg/dL



100-190 mg/dL


Elevated alpha-1-antitrypsin (AAT) clearance suggests excessive gastrointestinal protein loss. The positive predictive value of the test has been found to be 97.7% and the negative predictive value is 75%.


Patients with protein-losing enteropathies generally have AAT clearance values greater than 50 mL/24 hours and AAT fecal concentrations above 100 mg/dL.


Borderline elevations above the normal range are equivocal for protein-losing enteropathies.

Clinical Reference

1. Florent C, L'Hirondel C, Desmazures C, Aymes C, Bernier JJ: Intestinal clearance of alpha 1-antitrypsin. A sensitive method for the detection of protein losing enteropathy. Gastroenterology. 1981 Oct;81(4):777-780

2. Crossley JR, Elliott RB: Simple method for diagnosing protein-losing enteropathies. Br Med J. 1977 Feb 12;1(6058):428-429

3. Perrault J, Markowitz H: Protein-losing gastroenteropathy and the intestinal clearance of serum alpha-1-antitrypsin. Mayo Clin Proc. 1984 Apr;59(4):278-279

4. Schmidt PN, Blirup-Jensen S, Svendsen PJ, Wandall JH: Characterization and quantification of plasma proteins excreted in faeces from healthy humans. Scand J Clin Lab Invest. 1995 Feb;55(1):35-45

5. Davidson NO: Intestinal lipid absorption. In: Yamada T, Alpers DH, Kaplowitz N, eds. Textbook of Gastroenterology. JB Lippincott; 2003:413

6. Rybolt AH, Bennett RG, Laughon BE, Thomas DR, Greenough WB III, Bartlett JG: Protein-losing enteropathy associated with Clostridium difficile infection. Lancet. 1989 Jun 17;1(8651):1353-1355

7. Molina JF, Brown RF, Gedalia A, Espinoza LR: Protein losing enteropathy as the initial manifestation of childhood systemic lupus erythematosus. J Rheumatol. 1996 Jul;23(7):1269-1271

8. Umar SB, DiBaise JK: Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol. 2010 Jan;105(1):43-49

9. Levitt DG, Levitt MD: Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol. 2017 Jul;10:147-168

10. Murray FR, Morell B, Biedermann L, Schreiner P: Protein-losing enteropathy as precursor of inflammatory bowel disease: A review of the literature. BMJ Case Rep. 2021 Jan 11;14(1):e238802

Day(s) Performed

Monday through Friday

Report Available

Same day/1 to 2 days

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82103 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
A1AFS Alpha-1-Antitrypsin Clearance 93419-0


Result ID Test Result Name Result LOINC Value
AAT24 Alpha-1-Antitrypsin, 24 Hr, F 9407-8
AATS Alpha-1-Antitrypsin, S 6771-0
CRCLR Clearance 18271-7


If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information: