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Interpretive Handbook

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Test 200080 :
Hepatitis Profile, Serum

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

Hepatitis A:

Hepatitis A virus (HAV) is endemic throughout the world, occurring most commonly, however, in areas of poor hygiene and low socioeconomic conditions. The virus, which is transmitted primarily by the fecal-oral route, is spread by close person-to-person contact and by food- and water-borne epidemics. Outbreaks frequently occur in overcrowded situations and in high-density institutions and centers, such as prisons and health care or day care centers. Viral spread by parenteral contact (with blood or oropharyngeal secretions) is possible but rare, because infected individuals are viremic for a short period of time (usually less than 3 weeks). There is little or no evidence of transplacental transmission from mother to fetus, or of newborns contracting HAV infection during delivery.

 

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 chronic carriers are asymptomatic.

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

Screening to determine a patient's previous exposure and/or immunity to hepatitis A and B

Interpretation Provides information to assist in interpretation of the test results

Hepatitis A virus (HAV) infection:

Anti-HAV is usually almost detectable by the onset of symptoms (15-45 days after exposure). Serological diagnosis of acute viral hepatitis A depends on the detection of IgM antibody and its presence indicates recent exposure and the possibility to be potentially infectious. Anti-HAV IgG rises quickly once the virus is cleared and persists for years. A positive anti-HAV (IgG and IgM) indicates that the patient has had either a recent or past HAV infection.

 

Hepatitis B virus (HBV) infection:

Hepatitis B surface antigen (HBsAg) is the first serological marker present following HBV infection. A positive result is diagnostic of acute or chronic hepatitis B infection and is associated with infectivity. Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg. In acute cases, HBsAg usually disappears 1 to 2 months following 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 core antibody (anti-HBc) IgM can be detected in serum shortly after the onset of symptoms and is usually present up to 6 months (ie, core window period). Anti-HBc IgM may be the only serologic marker of a recent hepatitis B infection detectable following the disappearance of HBsAg and prior to the appearance of anti-HBs.

 

See Viral Hepatitis Serologic Profiles in Special Instructions.

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 (HBsAg) test results should be reported by the attending physician to the State Department of Health, as required by law in some states.

 

A weakly positive anti-HBc test result unaccompanied by other hepatitis B serologic markers, elevated liver enzymes, or a history of risk factors may be a false-positive result.

 

Passively acquired anti-HBs (ie, transfusion, recent immune globulin treatment, etc) does not signify immunity.

 

Anti-HBs may fall below detectable levels with time.

 

Performance characteristics have not been established for heat inactivated specimens or specimen containing particulate matter.

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 CORE TOTAL ANTIBODY

Negative

 

HEPATITIS A ANTIBODY, IgG and IgM

Negative

 

HEPATITIS B SURFACE ANTIBODY

Unvaccinated: negative

Vaccinated: positive

 

HEPATITIS B SURFACE ANTIBODY, QUANTITATIVE

Unvaccinated: <5.0 mIU/mL

Vaccinated: > or =12.0 mIU/mL

 

See Viral Hepatitis Serologic Profiles in Special Instructions.

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

1. Sherlock S: Hepatitis B: the disease. Vaccine 1990;8 Suppl:S6-S9

2. Lemon SM: Type A viral hepatitis: epidemiology, diagnosis, and prevention. Clin Chem 1997 August;43(8 pt 2):1494-1499

3. Ciocca M: Clinical course and consequences of hepatitis A infection. Vaccine 2000;18 Suppl 1: S71-74


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