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Test ID: CRHEP Chronic Hepatitis (Unknown Type), Serum


Necessary Information


Date of draw is required.



Specimen Required


Collection Container/Tube: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 3 mL

Collection Instructions: 

1. Centrifuge blood collection tube per collection tube manufacturer's instructions.

2. Aliquot serum into plastic vial.


Useful For

Diagnosis and evaluation of patients with symptoms of hepatitis with a duration more than 6 months

 

Distinguishing between chronic hepatitis B and chronic hepatitis C

Profile Information

Test ID Reporting Name Available Separately Always Performed
HBC HBc Total Ab, S Yes Yes
HBAB HBs Antibody, S Yes Yes
HBAG HBs Antigen, S Yes Yes
HCVDX HCV Ab w/Reflex to HCV PCR, S Yes Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
HCVQN HCV RNA Detect/Quant, S Yes No
HBGNT HBs Antigen Confirmation, S No No

Testing Algorithm

If hepatitis C virus (HCV) antibody is reactive, then HCV RNA detection and quantification by real-time reverse transcription polymerase chain reaction will be performed at an additional charge.

 

If hepatitis B surface antigen is reactive, then confirmation will be performed at an additional charge.

 

The following algorithms are available in Special Instructions:

-Chronic Hepatitis C Treatment and Monitoring Algorithm: Direct Antiviral Antigen (DAA) Combination

-HBV Infection-Diagnostic Approach and Management Algorithm

-Hepatitis C: Testing Algorithm for Screening and Diagnosis

-Viral Hepatitis Serologic Profiles

Method Name

Chemiluminescence Immunoassay (CIA)

Reporting Name

Chronic Hepatitis Profile

Specimen Type

Serum SST

Specimen Minimum Volume

2.75 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum SST Frozen (preferred) 28 days
  Refrigerated  5 days

Clinical Information

Hepatitis B:

Hepatitis 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 (eg, blood transfusion, sharing of needles by drug addicts). The virus is also found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.

 

After a course of acute illness, HBV persists in approximately 10% of patients. Some of these carriers are asymptomatic; others develop chronic liver disease including cirrhosis and hepatocellular carcinoma.

 

Hepatitis C:

Hepatitis C virus (HCV) is an RNA virus that is a significant cause of morbidity and mortality worldwide. HCV is transmitted through contaminated blood or blood products or through other close, personal contacts. It is recognized as the cause of most cases of post-transfusion hepatitis. HCV shows a high rate of progression (>50%) to chronic disease. In the United States, HCV infection is quite common, with an estimated 3.5 to 4 million chronic HCV carriers. Cirrhosis and hepatocellular carcinoma are sequelae of chronic HCV.

 

The following algorithms are available in Special Instructions:

-Chronic Hepatitis C Treatment and Monitoring Algorithm: Direct Antiviral Antigen (DAA) Combination

-HBV Infection-Diagnostic Approach and Management Algorithm

-Hepatitis C: Testing Algorithm for Screening and Diagnosis

-Viral Hepatitis Serologic Profiles

Reference Values

HEPATITIS B SURFACE ANTIGEN

Negative

 

HEPATITIS B SURFACE ANTIBODY, QUALITATIVE/QUANTITATIVE

Hepatitis B Surface Antibody

Unvaccinated: negative

Vaccinated: positive

 

Hepatitis B Surface Antibody, Quantitative

Unvaccinated: <5.0 mIU/mL

Vaccinated: ≥12.0 mIU/mL

 

HEPATITIS B CORE TOTAL ANTIBODIES

Negative

 

HEPATITIS C ANTIBODY

Negative

 

Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.

Interpretation

Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.

 

Chronic Hepatitis B:

Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B viral (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either a chronic carrier state or chronic HBV infection.

 

Hepatitis B core antibodies (anti-HBc Ab) appear shortly after the onset of symptoms of HBV infection and soon after the appearance of HBsAg. The IgM subclass usually falls to undetectable levels within 6 months, and the IgG subclass may remain for many years.

 

Hepatitis B surface antibody (anti-HBs) usually appears with the resolution of hepatitis B virus infection after the disappearance of HBsAg.

 

If HBsAg and anti-HBc (total antibody) are positive and patient's condition warrants, consider testing for hepatitis Be antigen (HBeAg), anti-HBe, hepatitis B virus DNA (HBV-DNA) or anti-hepatitis D virus (anti-HDV).

 

Chronic Hepatitis C:

Anti-HCV is almost always detectable by the late convalescent and chronic stage of infection.

 

The serologic tests currently available do not differentiate between acute and chronic hepatitis C infections.

Clinical Reference

1. Wietzke P, Schott P, Braun F, Mihm S, Ramadori G: Clearance of HCV RNA in a chronic hepatitis C virus-infected patient during acute hepatitis B virus superinfection. Liver. 1999;19:348-353

2. Villari D, Pernice M, Spinella S, et al: Chronic hepatitis in patients with active hepatitis B virus and hepatitis C virus combined infections: A histological study. Am J Gastroenterol. 1995;90:955-958

3. Bonino F, Piratvisuth T, Brunetto MR, Liaw YF: Diagnostic markers of chronic hepatitis B infection and disease. Antivir Ther. 2010;15(3):35-44

4. American Association for the Study of Liver Diseases and Infectious Diseases Society of America: HCV guidance: Recommendations for testing, managing, and treating hepatitis C. Accessed September 29, 2020. Available at  www.hcvguidelines.org/content

5. Badur S, Akgun A: Diagnosis of hepatitis B infections and monitoring of treatment. J Clin Virol. 2001;21:229-237

6. LeFebre ML, U.S. Preventive Services Task Force: Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2014;161:58-66 doi:10.7326/M14-1018

7. Jackson K, Locarnini S, Gish R: Diagnostics of hepatitis B virus: Standard of care and investigational.  Clin Liver Dis (Hoboken). 2018;12(1):5-11 doi: 10.1002/cld.729.

8. Coffin CS, Zhou K, Terrault NA: New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterol. 2019;156:355-368doi: 10.1053/j.gastro.2018.11.037.

9. WHO Guidelines Development Group: World Health Organization Guidelines on hepatitis B and C testing. World Health Organization; 2017. Accessed September 29, 2020. Available at www.who.int/hepatitis/publications/guidelines-hepatitis-c-b-testing/en/

10. Centers for Disease Control and Prevention. Testing and public health management of persons with chronic hepatitis B virus infection. Accessed April 8, 2020. Available at www.cdc.gov/hepatitis/hbv/testingchronic.htm

Day(s) and Time(s) Performed

Monday through Saturday; Varies

Analytic Time

1 day

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86704

86706

86803

87340

87341 (if appropriate)

87522 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CRHEP Chronic Hepatitis Profile 92889-5

 

Result ID Test Result Name Result LOINC Value
HCVA4 HCV Ab, S 13955-0
H_BAG HBs Antigen, S 5196-1
HBC HBc Total Ab, S 13952-7
HB_AB HBs Antibody, S 10900-9
HBSQN HBs Antibody, Quantitative, S 5193-8

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-liver-hepatitis