hepatitis serology cheat sheet

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 NYC Departme nt of Health and Me ntal Hygie ne, Bureau o f Communicable Disea se November 2013 Summary of Viral Hepatitis Lab Tests Reportable Not reportable Hep A Hep A virus antibody IgM (report if positive or borderline)  Hep A virus antibody  total Hep B Hep B Surface An tigen (HBsAg) - Only the confirmatory HBsAg should be reported Hep B Core Antibody IgM (HBcIgM) (report if positive; do not report if borderline)  Hep B “e” antigen (HBeAg) Hep B DNA (e.g., PCR or bDNA) Hep B genotype Hep B Surface Antibody (anti-HBs) Hep B Core Antibody total (anti-HBc) Hep B “e” Antibody (HBeAb) Hep C Hep C antibody with high-positive signal to cut off ratio ( s/co) Hep C RNA (e.g., PCR or bDNA) Hep C genotype Hep C EIA positive without s/co Hep C EIA with low-positive s/co Hep D Hep D IgM Hep D Ag Hep D IgG or total Hep E Hep E IgM Hep E IgG or total ALT Report ALT value if it is on the same accession number as a positive reportable hepatitis test. This is especially important with hepatitis A IgM and hepatitis B core IgM.  See below for details

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8/10/2019 Hepatitis Serology Cheat Sheet

http://slidepdf.com/reader/full/hepatitis-serology-cheat-sheet 1/4

 

NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013

Summary of Viral Hepatitis Lab Tests

Reportable Not reportable

Hep A Hep A virus antibody IgM (report if

positive or borderline) Hep A virus antibody – total

Hep B Hep B Surface Antigen (HBsAg) -Only the confirmatory HBsAgshould be reported

Hep B Core Antibody IgM (HBcIgM)(report if positive; do not report if borderline) 

Hep B “e” antigen (HBeAg)

Hep B DNA (e.g., PCR or bDNA)

Hep B genotype

Hep B Surface Antibody (anti-HBs)

Hep B Core Antibody total (anti-HBc)

Hep B “e” Antibody (HBeAb) 

Hep C Hep C antibody with high-positivesignal to cut off ratio (s/co)

Hep C RNA (e.g., PCR or bDNA)

Hep C genotype

Hep C EIA positive without s/co

Hep C EIA with low-positive s/co

Hep D Hep D IgMHep D Ag

Hep D IgG or total

Hep E Hep E IgM Hep E IgG or total

ALT Report ALT value if it is on the sameaccession number as a positivereportable hepatitis test. This isespecially important with hepatitis AIgM and hepatitis B core IgM. 

See below for details

8/10/2019 Hepatitis Serology Cheat Sheet

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NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013

Hepatitis AHepatitis A virus Antibody IgM (Reportable) 

  Usually indicates acute infection

  Can also indicate recent vaccination

  High false-positive rate, especially in patients without clinical signs of hepatitis.

Hepatitis A virus Antibody – total (Not reportable)   Indicates acute or resolved infection

  After successful vaccination, can be negative or positive

Hepatitis BHepatitis B Core Antibody IgM (HBcIgM) (Reportable) 

  Usually indicates acute (new) infection with hepatitis B virus

  High false-positive rate, especially in:o  patients without clinical signs of hepatitiso  patients with chronic hepatitis B

Hepatitis B Core Antibody total (anti-HBc) (Not r eportable) 

  Indicates acute, chronic or resolved hepatitis B virus infection

Hepatitis B Surface Antigen (HBsAg) (Reportable only if confirmatory sAg is positive) 

  Indicates acute or chronic infection

  Indicates that patient is infectious 

  Can be identified in serum 30-60 days after exposure to hepatitis B virus and persists forvariable periods

  If patient was vaccinated in the prior 6 weeks, a positive result may not be meaningful

Hepatitis B Surface Antibody (anti-HBs) (Not r eportable) 

 

Produced following a natural infection or vaccination   The vaccine includes surface protein only, not core protein. Therefore, vaccinated

individuals are anti-HBs positive but anti-HBc negative 

  If anti-HBs is negative, the patient is susceptible. 

Hepatitis B “e” Antigen (HBeAg) (Reportable) 

  Present in patients with high levels of virus

Hepatitis B “e” Antibody (HBeAb) (Not r eportable) •  Used in association with the HBeAg test to monitor course of infection and treatment

Hepatitis B DNA viral detection test (HBV DNA) (Reportable) 

 

Detects the hepatitis B virus in the blood

  Indicates that patient is infectious

  Results can be Qualitative (positive or negative) orQuantitative (viral load, copies per ml or units per ml)

Hepatitis B genotype (Reportable) 

  Indicates the strain of the virus - Not frequently ordered 

8/10/2019 Hepatitis Serology Cheat Sheet

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NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013

Hepatitis C

There is no lab test to distinguish acute from chronic hepatitis C infection.

Hepatitis C Antibody testsWill remain positive even if the infection is resolved.

Hepatitis C EIA (Enzyme ImmunoAssay)

  If positive, RNA test should be ordered to determine infection status

  Screening test, reportable if signal to cut off ratio is high (see below)

Hepatitis C EIA with signal to cut off ratio (s/co) (Reportable if s/co is high) 

  If positive, RNA test should be ordered to determine infection statuso

  If s/co is above the high threshold (e.g., => 3.8 or 8.0, depending on the assay) it isreportable

o  If s/co is low positive (e.g., between 1.0 and 3.7, depending on the assay), do notreport.

  For s/co thresholds for the various commercial assays, see:

http://www.cdc.gov/hepatitis/HCV/LabTesting.htm#section1  

Tests for hepatitis C virusA positive nucleic acid test (NAT) indicates infection, but does not indicate whether the infection isacute (new) or chronic

RNA (e.g., Polymerase chain reaction (PCR) or bDNA) (Reportable)

  Detects the hepatitis C virus in the blood. There are two kinds:o  Qualitative (result is detected or not detected) oro  Quantitative (result is viral load, IU per ml); used to monitor response to treatment

Hepatitis C genotype (Reportable) 

 

Indicates the strain of the virus, e.g., 1a  Different genotypes require different antiviral treatment regimens

8/10/2019 Hepatitis Serology Cheat Sheet

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NYC Department of Health and Mental Hygiene, Bureau of Communicable Disease November 2013

Hepatitis D

Hepatitis D can only cause infection when hepatitis B is also present. 

Hepatitis D IgM (Reportable)

 

Usually indicates an acute infection with hepatitis D 

Hepatitis D Ag (Reportable)

  Indicates that the patient has hepatitis D

Hepatitis E

Hepatitis E IgM (Reportable) 

 Usually indicates an acute infection

 

High false-positive rate

Liver Function Tests (LFTs)AST=SGOTALT=SGPT

For both tests, the normal range (reference range) varies & should therefore be reported with the testresult. The normal range is typically around 20-50 for both tests.

Generally with viral hepatitis: ALT value is higher than AST.Generally with alcohol-induced liver damage: AST is higher than ALT, sometimes much higher.

ALT should be reported along with any positive reportable hepatitis serology tests. This is especiallyimportant with hepatitis A IgM and hepatitis B core IgM tests.