Hepatitis B Core Total Antibodies, with Reflex to Hepatitis B Core Antibody IgM, Serum
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
During the course of a typical case of acute hepatitis B viral (HBV) infection, IgM antibodies to hepatitis B core antigen (anti-HBc IgM) are present in the serum shortly before clinical symptoms appear. Anti-HBc total is detectable during the prodromal, acute, and early convalescent phases when it exists as immunoglobulin M (IgM) anti-HBc. Anti-HBc IgM rises in level and is present during the core window period, ie, after hepatitis B surface antigen disappears and before antibodies to hepatitis B surface antigen appear. Anti-HBc total may be the only serologic marker remaining years after exposure to HBV.
Detection and differentiation between recent and past/resolved or chronic hepatitis B viral (HBV) infection
Diagnosis of recent HBV infection during the "window period" when both hepatitis B surface antigen and antibodies to hepatitis B surface antigen are negative
A positive, antibodies to hepatitis B core antigen (anti-HBc) total result may indicate, either, recent, past/resolved, or chronic hepatitis B viral (HBV) infection.
Testing for anti-HBc IgM (HBIM / Hepatitis B Core Antibody IgM, Serum) is necessary to confirm the presence of acute or recent hepatitis B. A positive anti-HBc total result with a negative anti-HBc IgM result indicates past or chronic HBV infection. Differentiation between past/resolved and chronic hepatitis B can be based on the presence of hepatitis B surface antigen in the latter condition.
Negative anti-HBc total results indicate the absence of recent, past/resolved, or chronic hepatitis B.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
For 24 hours before blood collection, patient should not take multivitamins or dietary supplements containing biotin (vitamin B7) that is commonly found in hair, skin, and nail supplements and multivitamins.
Not useful for determining immunity to or recovery from hepatitis B viral (HBV) infection.
Positive antibodies to hepatitis B core antigen (anti-HBc) total results with negative anti-HBc IgM results in infants younger than 18 months old may be due to passively acquired maternal IgG antibodies. Additional testing, such as hepatitis B surface antigen, anti-HBc IgM, and hepatitis Be antigen, are necessary to confirm a diagnosis of acute or recent hepatitis B in these infants.
Performance characteristics have not been established for the following specimen characteristics:
-Grossly icteric (total bilirubin level of >20 mg/dL)
-Grossly lipemic (triolein level of >3,000 mg/dL)
-Grossly hemolyzed (hemoglobin level of >500 mg/dL)
-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.
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. Bonino F, Piratvisuth T, Brunetto MR, et al: Diagnostic markers of chronic hepatitis B infection and disease. Antiviral Therapy 2010;15(3):35-44
2. Badur S, Akgun A: Diagnosis of hepatitis B infections and monitoring of treatment. J Clin Virol 2001;21(3):229-237
3. Servoss JC, Friedman LS: Serologic and molecular diagnosis of hepatitis B virus. Clin Liver Dis 2004;8(2):67-281