hepatitis serology cheat sheet
TRANSCRIPT
8/10/2019 Hepatitis Serology Cheat Sheet
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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
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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.