Hepatitis B Virus Testing

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INDICATIONS FOR TESTING INDICATIONS FOR TESTING

Acute onset Chronic
Jaundice Moderately elevated transaminases
Viral illness (Possible past history of hepatitis)

ORDER
ORDER
Hepatitis Panel, Acute with Reflex to HBsAg Confirmation Hepatitis B Virus Surface Antigen with Reflex to Confirmation
(includes the following):
Hepatitis B Virus Core Antibodies (Total)
Hepatitis A Virus Antibody, IgM
Hepatitis B Virus Surface Antibody
Hepatitis B Virus Surface Antigen with Reflex to Confirmation
AND
Hepatitis B Virus Core Antibody, IgM
Hepatitis C Virus Antibody by CIA
Hepatitis C Virus Antibody by CIA

HCV positive
HBV surface antigen + Acute HBV
HBV core IgM abs + Follow to determine resolution
Please see Hepatitis C Virus Testing Algorithm

Repeat test in 4-6 wks

HBV surface antigen +

HBV core abs + Chronic HBV likely
HBV surface antigen + Possibly chronic HBV or
HBV surface abs -
HBV core IgM abs - contamination of specimen

Repeat test 4-6 wks Repeat test in 4-6 wks If testing

confirms
To monitor therapy, use HBV,
HBV surface antigen - HBV PCR, HBsAg, consider
HBV infection probably resolving
HBV core IgM abs + HBsAb, HBeAg, Hepatitis B
HBeAb Virus
Hepatitis B Virus by Genotype by
Consider other etiologies Quantitative PCR
Viral Sequencing
Cytomegalovirus
Epstein-Barr virus
Herpes simplex virus
Varicella-zoster virus
Hepatitis A, C, D or E HBV surface antigen - False + anti-HBc or chronic infection
Toxin exposure
Alcohol HBV core abs + Consider HBV PCR testing and/or HBV
Tetrachloride HBV surface abs - vaccine followed by repeat HBV serology
Nonalcoholic acute steatohepatitis
Drug-induced hepatitis
Acetaminophen
Antiseizure medications
Isoniazid (Nydrazid) Repeat test in 4-6 wks
Oral contraceptives To monitor therapy, use HBV PCR,
Rifampin (Rifadin) HBsAg, HBsAb, HBeAg and HBeAb
Sulfonamides
Autoimmune
HBV surface Systemic lupus erythematosus
antigen - Primary biliary cirrhosis HBV surface antigen -
HBV core IgM Sclerosing cholangitis
Autoimmune hepatitis
HBV core abs + Recovered from HBV infection
abs - HBV surface abs +
Bacterial
Leptospira spp
Coxiella burnetii (Q-fever)
Rickettsia rickettsii (Rocky Mountain spotted
fever) HBV surface antigen -
Treponema pallidum (Secondary syphilis) Expected serology response from
Sepsis
HBV core abs -
HBV vaccine
Rickettsia typhi (typhus fever) HBV surface abs +
Granulomatous
M. tuberculosis
Sarcoidosis
Hereditary Test Key
Wilson disease
Hemochromatosis HBV PCR - Hepatitis B Virus by Quantitative PCR
Alpha-1-antitrypsin deficiency HBeAg – Hepatitis Be Virus Antigen
Ischemia HBeAb – Hepatitis Be Virus Antibody
Parasitic HBsAb – Hepatitis B Virus Surface Antibody
Liver trematodes
Toxocara spp HBsAg – Hepatitis B Virus Surface Antigen with Reflex to Confirmation

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