Acute Hepatitis Profile with Hepatitis C Virus Reflex

CPT CODE:

USEFUL FOR:

Differential diagnosis of acute viral hepatitis

SPECIMEN REQUIRED:

Draw blood in a plain, red-top tube(s) or a serum gel tube(s). (Plasma is not acceptable.) Spin down, remove serum from clot within 24 hours,and send 2.5 mL of serum frozen in plastic vial.Note:     Draw date is required on request form for processing.

TRANSPORT TEMPERATURE:

Frozen\Refrig <48 hours OK\Ambient NO

CLINICAL INFORMATION:

Hepatitis AHepatitis A virus (HAV) is an RNA virus (an enterovirus) that accountsfor 20% to 25% of the viral hepatitis in United States adults. HAVinfection is spread by the oral/fecal route and results in acutehepatitis with usually a benign, self-limited course. Spread of thedisease is usually associated with contaminated food or watercaused by poor sanitary conditions. Outbreaks frequently occur inovercrowded situations and in institutions or high density centerssuch as prisons and health care centers. Epidemics may occurfollowing floods or other disaster situations. Chronic carriers ofHAV have never been observed.
Hepatitis BHepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products, e.g., blood transfusion, andsharing of needles by drug addicts. The virus is also found inall types of human body fluid and is known to be spreadthrough oral and genital contact. HBV can be transmitted frommother to child during delivery through contact with blood andvaginal secretions, but it is not commonly transmitted transplacentally.After a course of acute illness, HBV persists in approximately 10%of patients. While some of these chronic carriers are asymptomatic,others develop chronic liver disease, including cirrhosis andhepatocellular carcinoma.
Hepatitis CHepatitis C virus (HCV) is an RNA virus that is a significant causeof morbidity and mortality worldwide. HCV is transmitted throughcontaminated blood or blood products or through other close,personal contacts. It is recognized as the cause of most cases ofposttransfusion hepatitis. HCV shows a high rate of progression(>50%) to chronic disease. In the United States, HCV infection isquite common, with an estimated 3.5 to 4 million chronic HCVcarriers. Cirrhosis and hepatocellular carcinoma are sequelae ofchronic HCV.
See "Advances in the Laboratory Diagnosis of Hepatitis C" (2002) inPublications, and "HBV Infection-Diagnostic Approach andManagement Algorithm" and "Recommended Approach to the Diagnosis and Monitoring of Patients with Hepatitis C Virus" in Special Instructions.

CLINICAL INTERPRETATION:

See individual unit codes.
See "HBV Infection-Diagnostic Approach and Management Algorithm"and "Recommended Approach to the Diagnosis and Monitoring of Patients with Hepatitis C Virus" in Special Instructions.
If screening test results for HAV, HBV, and HCV infection are negative in a patient with signs and symptoms consistent with acute hepatitis, consider testing for Epstein-Barr virus or cytomegalovirus as possibleetiologic agents.

REFERENCE VALUES:

HEPATITIS B SURFACE ANTIGEN

      Negative

HEPATITIS A IgM ANTIBODY

      Negative

HEPATITIS B CORE ANTIBODY, IgM (ANTI-HBc, IgM)

      Negative

HEPATITIS C ANTIBODY SCREEN

      Negative

Interpretation depends on clinical setting. See "Viral Hepatitis

Serologic Profiles" in Special Instructions.