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Hepatitis Serology


Hepatitis labs AST/ALT very high (20x nml) early; WBC nml to low; TBil follows AST/ALT; alkphos parallels bili
ALT/AST in infxs hep: Usu ALT:AST > 1.0
ALT/AST in EtOH hepatitis: AST:ALT >1.0
Hepatitis: urine labs: mild proteinuria; bilirubinuria often precedes jaundice; may be incidental indicator of liver injury
Hep: liver not primary target in: EBV, CMV, other (HSV, yellow fever, mumps, rubella)
Hepatitis: liver is primary target in: hepatitis viruses
Hepatitis serum tests Immuno detection (EIA, RIA, RIBA, PCR); bx not for dx but useful for staging Hep C
Most common cause of chronic hep viral
Most common PREVENTABLE infxs dz Hep A
Dx of acute infxs hep is by presence of: IgM anti-HAV: indicates previous exposure to HAV, noninfectivity & immunity; past exposure common in US (30%); Total anti-HAV to screen ppl who may need vax
Hep B: more likely to become chronic if: young at age of infxn (or immunocompromised); 95% of pts clear the virus & develop Abs; chronic Hep B increases risk of cirrhosis & HCC
First evidence of hep B infxn (persists throughout clinical illness): HBsAg
Appears after clearance of HBsAg or successful vax vs Hep B Anti-HBs;
Detection of Anti-HBs indicates: recovery from HBV infxn, noninfectivity & immunity
Anti-HBc IgM Appears soon after HBsAg, before anti-HBs; presence w/ acute hep sx = acute Hep B; Persists 3-6 mos
Anti-HBc IgG Appears with Anti-HBc IgM, but persists
HBcAg: does not appear in serum
HBeAg: Secretory form of HBcAg; found only in HBsAg positive serum soon after its detection; Presence indicates viral replication & infectivity
Anti-HBe: Presence (after clearance of HBeAg) indicates: less viral replication & infectivity
Hep B immunity (types) Recovered from infxn: Anti-HBs pos, Anti-HBc IgG pos; vax: Anti-HBs pos, Anti-HBc IgG NEG
HBV DNA Parallels HBeAg, but is more sensitive/ precise marker of viral replication & infectivity; Low levels may persist in serum & liver after recovery from acute Hep B; HBV DNA in serum is bound to IgG & rarely infectious
Hep C characteristics high rate of chronic infxn (85%); cause of cryoglobulinemia; Dx: anti-HCV by ELISA, may need confirm w/HCV RNA & anti-HCV RIBA; Ab levels rise slowly
Only test for Hep D if: if pt has confirmed & unexplained worsening of Hep B
Hep D characteristics Requires HBsAg; worsens Hep B prognosis, inc risk of liver ca; Dx anti-HDV or HDV RNA in serum
Hep E characteristics Usu benign & self-limited; rare; 10-20% mortality in PG; Dx anti-HEV
DUMC acute hep panel HCV Ab; HBc IgM; HBs Ag; HAV IgM Ab
"window period" = serologic gap between the time HBSAg clears and antibody (HBS-Ag) becomes detectable
IgG Ab in presence of HBSAg indicates: chronic infection (in the absence of HBSAg = recovery)
Fibrosure = 6 biochemical marker test for HCV; correlates well with liver bx
Created by: Abarnard