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Hepatitis Serology
Gastroenterology
| Question | Answer |
|---|---|
| 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 |
| acute hep B eval | 1-4 mo incubation; 70% subclinical; ALT/AST 1000-2000 |
| HCV infxn sources | IVDU (most common); sex; bloodborne |
| Hepatitis labs | AST/ALT very high (20x nml) early; WBC nml to low; TBil follows AST/ALT; alkphos parallels bili |
| Hepatitis: urine labs: | mild proteinuria; bilirubinuria often precedes jaundice; may be incidental indicator of liver injury |
| Most common cause of chronic hepatitis | viral hepatitis |
| IgM anti-HAV signifies: | prior 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 serologic evidence of hep B infection = | HBsAg (persists throughout clinical illness) |
| Appears after clearance of HBsAg or successful vax vs Hep B | Anti-HBs |
| Anti-HBs detection signals: | recovery from HBV infxn, noninfectivity & immunity |
| Anti-HBc IgM appears when? | soon after HBsAg, before anti-HBs; presence w/ acute hep sx = acute Hep B; Persists 3-6 mos |
| Anti-HBc IgG appears when? | 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 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 | 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: | Requires HBsAg; worsens Hep B prognosis, inc risk of liver ca; Dx anti-HDV or HDV RNA in serum |
| Hep E | Usu benign & self-limited; rare; 10-20% mortality in PG; Dx anti-HEV |
| chronic hepatitis panel | HBCAb IgG, HBCAb IgM, HBSAg, HbSAb |
| Hep B: past infxn vs vax | PAST INFXN: pos HBSAb, HBCAb; neg HBSAg, HBeAg, var HBeAb. VAX: pos HBSAb, all others neg |
| Hep B labs: infectivity | HbeAg: infective; HbeAb: not actively infective; HBV DNA: Marker of ongoing infection |
Created by:
Abarnard
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