Hepatitis Panel
(defintion, 4 diseases tested)
Definition: series of blood tests used to evaluate for hepatitis
Diseases Tested:
- Hepatitis A Virus (HAV)
- Hepatitis B Virus (HBV)
- Hepatitis C Virus (HCV)
- Hepatitis D Virus (HDV)
Note: Testing entire panel is not usually favorable. Goal is to test for specific hepatitis depending on s/sx
Hepatitis Testing Indications
(2)
- Diagnose and identify serologic type of hepatitis
- Monitor current status/stage of hepatitis (c antibody progression analysis)
Hepatitis
(definition, 4 common causes, 3 common strains)
Def: viral liver inflammation
Conditions:
- Viral infection
- EtOH ingestion, usually chronic
- Drugs (specifically needle sharing)
- Bacterial sepsis
Common strains:
- A
- B
- C
Hepatits Presentation
(6 possitiblities)
- Asymptomatic (usually detected in LFTs, more common in Hep B or C)
- May have jaundice
- Can have massive liver necrosis
- Can lead to acute liver failure
- Can have chronic hepatitis
- Sometimes can result in chronic carrier state
Takeaway - always keep hepatitis on your radar, as it has a wide variety of vague s/sx
Hepatits Clinical Presentation
(6 aspects)
- Low grade fever
- Malaise
- Anorexia
- Fatigue
- Hepatomegaly
- Elevated LFTs
- Liver disease dependent: AST
- Non-liver disease dependent: ALT, LDH
Hepatitis A Virus
(alt name, incubation period, transmission, unique quality)
Name: Infectious hepatitis
Incubation: 2-6 weeks
Transmission: fecal-oral contam of food/drink. highly contagious! asst c outbreaks and can live on fomites
Unique: Complete recovery c normal LFTs
Hep. A Testing
- HAV – Ab / IgM
- Appear 3-4 weeks after exposure
- Present just before LFT’s elevate
- LFTs return to normal in 8 weeks
- HAV – Ab / IgG
- Appear 4 weeks after IgM begins to rise
- Can remain detectable for years after infection
Things to remember:
- IgM appears before IgG
- Hep. A IgM Ab takes much longer to dissipate than LFTs but not as long as IgGs
Hepatitis A Staging
(2 stages)
Acute: IgM Ab is elevated in absence of IgG Ab
Convalescent (or vaccinated): IgG is elevated in absence of IgM elevation
*Board Question
Hepatitis A Course
(describe test spike progression)
Hepatitis B Proteins
(list 3 and when they appear in bld testing)
- Surface protein antigen (sm, med, lg)
- sit on the surface of HBV
- first value elevated after infection’s start, may present before s/sx
- Core antigens
- sit on the surface of the core surrounding HBV DNA
- elevated after exposure to extracellular environment. core produced and surrounds DNA within hepatocyte. leaves hepatocyte to then get engulfed by surface protection. antibody exposed after leaving the hepatocyte
- only detectable via antibody test because they are not exposed in serum
- DNA polymerase antigen
- part of HBV DNA
- not really tested
Hepatitis B Virus
(alternate name, incubation period, transmission, prognosis)
Alt Name: serum hepatitis
Incubation: 5 weeks - 6 mo c avg of 2 mo
Transmission: body fluids
- blood transfusion (Red Cross tests prior to transfusions so incidence is low)
- mother → infant via placenta
- sharing needles
Prognosis: while recovery is possible, this can results in liver failure and death
People c HBV Risk
(7)
- Blood transfusion recipients
- IV drug abusers
- Transplant patients (immunocompromised and receiving others’ bld)
- Dialysis patients (via dialysis machine)
- Male homosexuals
- Patients with leukemia and lymphoma
- Hospital personnel
Hepatitis B Surface Antigen (HBsAg)
- First lab test to indicate infection
- Rises before clinical symptoms
- Indicates active HBV infection
- Will not appear in pts c vaccination but no infection
*This will almost positively be on the boards. *
Hepatitis B Surface Antibody (HBsAb)
(when is it present? how do you know? what does it mean?)
Appears:
- after disappearance of surface antigen
- in there will be a lag time between these two, usually b/w weeks 24 and 32! important for dx
- chronic Hep B the surface antigen will remain throughout
- min 3-4 weeks
- perminently in vaccinated pts (usually. titers can drop)
Signifies end of acute phase
Tested c antigen titer
denotes immunity after HBV vaccine or HBV infection
Hep B Core Antigen (HBcAg)
Appears:
- very transcient moment when HBV core leaves hepatocyte to inject into the outer surface
- technically present as long as there is viral production
Tested c antibody titer. since the core only exists in serum inside the outer surface, there are no antigen tests for it. Instead, must tests the antibody. This is undesirable, as antibodies will only present after a few weeks
- elevated during time lag between disappearance of HBsAg and appearance of HBsAB. key for not missing dx
Signifies:
- recent infection (within the last 6 mo)
- chronic hepatitis
this information is often tested on boards
HBV Window Period
Hepatitis B-e antigen (HBeAg)
(define, test, significance)
Def: Antigen on chemical secreted during active/infective period of HBV but is not part of the virus itself. Exact purpose is unknown
Test:
- HBeAg antigen assay
- HBeAg antibody assay
Significance: indicates level of infectivity of HBV
- Will reside after HBV infection is resolved
- Remains elevated in chronic HBV
- Highly activity of disease indicates higher chance of passing it to others. Instruct pts to keep body fluids to themselves - carry their own towels, utensils, etc
Typical Serologic Course - Acute Hep B c Recovery
Typical Serologic Course, Chronic Hepatitis B Infection
Reference, Serology Results in Stages of Acute and Chronic Hep B
List of Tests in Hep B Titer
(4)
- HBsAg
- Total anti-HBc
- IgM anti-HBc
- anti-HBs
Hepatitis C Virus
(alt name, transmission, incubation, prognosis)
alt name - non A, non B hepatitis
transmission - body fluids, mostly via blood transfusion
incubation - 2 to 12 weeks, avg at 6 to 8 weeks
prognosis - requires close monitoring because
- chronic 80% of time
- develop cirrhosis + hepatocellular cancers 20% of time
HCV Testing
(4)
- HCV – Ab / IgG
- EIA (Enzyme immunoassay) for HCV antibodies
- Antibodies develop within 4 weeks of onset of infection
- DNA/RNA testing - technically available but rarely done due to high cost and minimal difference form existing tests
Typical Serology Course, Acute HCV Infection c Recovery
