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HelpTest ID: AHEP Acute Viral Hepatitis Profile, Serum
Necessary Information
Date of collection is required.
Specimen Required
Patient Preparation: For 24 hours before specimen collection, patient should not take multivitamins or dietary supplements (eg, hair, skin, and nail supplements) containing biotin (vitamin B7).
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube: Serum gel (red-top tubes are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 2.7 mL
Collection Instructions:
1. Centrifuge blood collection tube per manufacturer's instructions (eg, centrifuge and aliquot within 2 hours of collection for BD Vacutainer tubes).
2. Aliquot 2 mL serum into a plastic vial labeled as SST Serum, and ship frozen (preferred).
Useful For
Differential diagnosis of recent acute viral hepatitis
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HAIGM | Hepatitis A IgM Ab, S | Yes | Yes |
| HBAG | HBs Antigen, S | Yes | Yes |
| HBIM | HBc IgM Ab, S | Yes | Yes |
| HCVDX | HCV Ab w/Reflex to HCV PCR, S | Yes | Yes |
Testing Algorithm
If the hepatitis C virus (HCV) antibody result is reactive, then HCV RNA detection and quantification by real-time reverse transcription-polymerase chain reaction will be performed at an additional charge.
If the hepatitis B surface antigen result is reactive, then confirmation will be performed at an additional charge.
The following algorithms are available:
-Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Special Instructions
Method Name
HAIGM, HBAG, HBIM, HCVDX, HBGNT: Electrochemiluminescence Immunoassay (ECLIA)
HCVQN: Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Reporting Name
Acute Hepatitis ProfileSpecimen Type
Serum SSTSpecimen Minimum Volume
1.9 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum SST | Frozen (preferred) | 84 days | |
| Refrigerated | 6 days |
Reference Values
HEPATITIS B SURFACE ANTIGEN
Negative
HEPATITIS B SURFACE ANTIGEN CONFIRMATION
Negative
HEPATITIS B CORE IgM ANTIBODY
Negative
HEPATITIS A IgM ANTIBODY
Negative
HEPATITIS C ANTIBODY
Negative
HEPATITIS C VIRUS RNA DETECTION AND QUANTIFICATION BY REAL-TIME RT-PCR
Undetected
Interpretation
Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles
Hepatitis A Virus (HAV):
HAV-specific antibodies are usually detectable by the onset of symptoms (usually 15 to 45 days after exposure). The initial antibody consists almost entirely of IgM subclass antibody. Anti-HAV IgM usually falls to undetectable levels 3 to 6 months after infection.
Hepatitis B Virus (HBV):
HBsAg is the first serologic marker appearing in the serum 6 to 8 weeks following HBV infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Anti-HBs appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appear as the immune response following a course of inoculation with the hepatitis B vaccine.
During acute hepatitis B in symptomatic individuals, detectable anti-HBc consists almost entirely of the IgM subclass. Anti-HBc IgM can be detected shortly after the onset of symptoms and usually remains detectable for 6 months. Anti-HBc IgM and Anti-HBc total may be the only serologic markers of a recent HBV infection detectable in the "window period", during which HBsAg has declined to become undetectable and anti-HBs has not yet become detectable.
Hepatitis C Virus (HCV):
In immunocompetent individuals, HCV-specific IgG and IgM antibodies are usually not detectable in the first 2 months after exposure to HCV, and this "window period: may be as long as 6 months in immunocompromised individuals. HCV antibodies are not neutralizing and does not provide immunity against subsequent HCV infection.
If HBsAg, anti-HAV IgM, and anti-HCV are negative and patient's condition warrants, consider testing for Epstein-Barr virus or cytomegalovirus.
The following algorithms are available:
-Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Clinical Reference
1. LeFevre ML, et al. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(1):58-66. doi:10.7326/M14-1018
2. 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
3. Coffin CS, Zhou K, Terrault NA. New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterology. 2019;156(2):355-368.e3. doi:10.1053/j.gastro.2018.11.037
4. World Health Organization. Guidelines on hepatitis B and C testing. 2017. Accessed August 12, 2024. Available at www.who.int/hepatitis/publications/i/item/9789241549981
5. Centers for Disease Control and Prevention. Screening and testing for hepatitis B virus infection: CDC Recommendations - United States, 2023. MMWR Recomm Rep; 2023:72(No. RR-1):1-25. Available at www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm?s_cid=rr7201a1_w
Day(s) Performed
Monday through Saturday
Report Available
Same day/1 to 2 daysTest Classification
This test has been cleared, approved, or is exempt by the US 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
80074 (if all 4 initial tests are performed)
86709 (if all 4 are not performed)
86705 (if all 4 are not performed)
87340 (if all 4 are not performed)
86803 (if all 4 are not performed)
87522 (if appropriate)
87341 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| AHEP | Acute Hepatitis Profile | 24363-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| HCVA4 | HCV Ab, S | 40726-2 |
| HBIM | HBc IgM Ab, S | 24113-3 |
| H_BAG | HBs Antigen, S | 5196-1 |
| HAIGM | Hepatitis A IgM Ab, S | 13950-1 |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HCVQN | HCV RNA Detect/Quant, S | Yes | No |
| HBGNT | HBs Antigen Confirmation, S | Yes | No |
Forms
If not ordering electronically, complete, print, and send 1 of the following:
Clinical Information
Hepatitis A:
Hepatitis A virus (HAV) is an RNA virus that accounts for 20% to 25% of acute viral hepatitis in adults in the United States. Hepatitis A is spread by the oral/fecal route and produces acute hepatitis, which follows a benign, self-limited course. Spread of the disease is usually associated with contaminated food or water caused by poor sanitary conditions. Outbreaks frequently occur in overcrowded situations and institutions or high-density centers such as prisons and healthcare centers. Epidemics may occur following floods or other disaster situations. Chronic carriers of HAV have never been observed.
Hepatitis B:
Hepatitis B virus (HBV) is an endemic DNA virus throughout the world. The infection is spread primarily through percutaneous contact with infected blood products (eg, blood transfusion, sharing of needles among injection drug users). The virus is also found in virtually every 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 chronic 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. The infection is transmitted through contaminated blood or blood products or other close, personal contacts. It is recognized as the cause of most cases of posttransfusion hepatitis. Hepatitis C shows a high rate of progression (~75%) to chronic infection and disease and accounts for the majority of chronic viral hepatitis In the United States. Cirrhosis and hepatocellular carcinoma are sequelae of chronic infection with this virus.
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