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Interpretive Handbook

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Test 9025 :
Chronic Hepatitis Profile (Type Unknown)

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Hepatitis B:

Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products, eg, blood transfusion, sharing of needles by drug addicts. The virus is also found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.

 

After a course of acute illness, HBV persists in approximately 10% of patients. Some of these carriers are asymptomatic; others develop chronic liver disease including cirrhosis and hepatocellular carcinoma.

 

Hepatitis C:

Hepatitis C virus (HCV) is an RNA virus that is a significant cause of morbidity and mortality worldwide. HCV is transmitted through contaminated blood or blood products or through other close, personal contacts. It is recognized as the cause of most cases of posttransfusion hepatitis. HCV shows a high rate of progression (>50%) to chronic disease. In the United States, HCV infection is quite common, with an estimated 3.5 to 4 million chronic HCV carriers. Cirrhosis and hepatocellular carcinoma are sequelae of chronic HCV.

 

Publications:

-Advances in the Laboratory Diagnosis of Hepatitis C (2002)

 

The following algorithms are available in Special Instructions:

-HBV Infection-Diagnostic Approach and Management Algorithm

-Testing Algorithm for the Diagnosis of Hepatitis C

-Viral Hepatitis Serologic Profiles

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosis and evaluation of patients with symptoms of hepatitis with a duration >6 months

 

Distinguishing between chronic hepatitis B and chronic hepatitis C

Interpretation Provides information to assist in interpretation of the test results

Hepatitis B:

Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B virus (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either a chronic carrier state or chronic liver disease.

 

Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appears as the immune response following a course of inoculation with the hepatitis B vaccine.

 

Hepatitis B core antibody (anti-HBc) appears shortly after the onset of symptoms of HBV infection. The IgM subclass usually falls to undetectable levels within 6 months, while the IgG subclass may remain for many years and may be the only serologic marker remaining years after exposure to hepatitis B.

 

If HBsAg and anti-HBc (total antibody) are positive and the patient's condition warrants, consider testing for hepatitis B envelope antigen (HBeAg), hepatitis B envelope antibody (anti-HBe), HBV-DNA, or hepatitis delta virus antibody (anti-HDV).

 

Hepatitis C:

Hepatitis C virus (HCV) antibody is usually not detectable during the early months following infection, but is almost always detectable by the late convalescent stage of infection. The serologic tests currently available do not differentiate between acute and chronic HCV infections. HCV antibody is not neutralizing and does not provide immunity.

 

Publications:

-Advances in the Laboratory Diagnosis of Hepatitis C (2002)

 

The following algorithms are available in Special Instructions:

-HBV Infection-Diagnostic Approach and Management Algorithm

-Testing Algorithm for the Diagnosis of Hepatitis C

-Viral Hepatitis Serologic Profiles

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Positive hepatitis B surface antigen test results should be reported by the attending physician to the State Department of Health, as required by law in some states.

 

Consider administration of hepatitis B immune globulin and hepatitis B vaccine to individuals exposed to the patient's blood and/or body fluids.

 

If clinically indicated, testing for HBIM / Hepatitis B Core Antibody, IgM, Serum should be ordered to confirm an acute or recent infection.

 

Neonates (<1 month old) with positive hepatitis B core (anti-HBc) total antibody results from this assay method should be tested for anti-HBc IgM antibody to rule-out possible maternal anti-HBc total antibody causing false-positive results. Repeat testing for anti-HBc total antibody within 1 month is also recommended in these anti-HBc total antibody-positive neonates.

 

Performance characteristics have not been established for the following specimen characteristics:

-Grossly icteric (total bilirubin level of >20 mg/dL)

-Grossly lipemic (triglyceride level of >3,000 mg/dL)

-Grossly hemolyzed (hemoglobin level of >500 mg/dL)

-Containing particulate matter

-Cadaveric specimens

-Body fluids other than serum (eg, saliva, urine, CSF, amniotic, peritoneal, or pleural fluids)

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

HEPATITIS B SURFACE ANTIGEN

Negative 

 

HEPATITIS B SURFACE ANTIBODY, QUALITATIVE/QUANTITATIVE

Hepatitis B Surface Antibody

Unvaccinated: negative

Vaccinated: positive

Hepatitis B Surface Antibody, Quantitative

Unvaccinated: <5.0 mIU/mL

Vaccinated: > or =12.0 mIU/mL

 

HEPATITIS B CORE TOTAL ANTIBODIES

Negative

 

HEPATITIS C ANTIBODY SCREEN

Negative

 

Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Wietzke P, Schott P, Braun F, et al: Clearance of HCV RNA in a chronic hepatitis C virus-infected patient during acute hepatitis B virus superinfection. Liver 1999;19:348-353

2. Villari D, Pernice M, Spinella S, et al: Chronic hepatitis in patients with active hepatitis B virus and hepatitis C virus combined infections: a histological study. Am J Gastroenterol 1995;90:955-958

3. Schmilovitz-Weiss H, Levy M, Thompson N, Dusheiko G: Viral markers in the treatment of hepatitis B and C. Gut 1993;34 (2 Suppl):S26-S35


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