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HelpTest ID: AHEP Acute Hepatitis Profile, Serum
Necessary Information
Date of collection is required.
Specimen Required
Both 0.5 mL of refrigerated serum and 2.5 mL of frozen serum are preferred for this test.
Patient Preparation: For 24 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.
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. Transfer 0.5 mL serum into an aliquot tube labeled as HAIGM, and ship refrigerate (required).
3. Transfer remaining 2.5 mL serum into a second aliquot tube 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 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 Bs antigen 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: Chemiluminescent Microparticle Immunoassay (CMIA)
HBAG, HBIM, HCVDX, HBGNT: Chemiluminescence Immunoassay (CIA)
HCVQN: Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Reporting Name
Acute Hepatitis ProfileSpecimen Type
SerumSerum SST
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated | 5 days | |
| Serum SST | Frozen (preferred) | 28 days | |
| Refrigerated | 5 days |
Clinical Information
Hepatitis A:
Hepatitis A virus (HAV) is an RNA virus that accounts for 20% to 25% of the viral hepatitis in United States adults. HAV infection 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 in institutions or high-density centers such as prisons and health care 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 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 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. 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 posttransfusion 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:
-Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
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 depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.
Interpretation
Hepatitis A:
Antibody against hepatitis A antigen is usually detectable by the onset of symptoms (usually 15-45 days after exposure). The initial antibody consists almost entirely of IgM subclass antibody. Antibody to hepatitis A virus (anti-HAV) IgM usually falls to undetectable levels 3 to 6 months after infection.
Hepatitis B:
Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B virus (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg. Anti-HBs also appears as the immune response following a course of inoculation with the hepatitis B vaccine.
Initially, hepatitis B core antibody (anti-HBc) consists almost entirely of the IgM subclass. Anti-HBc, IgM can be detected shortly after the onset of symptoms and is usually present for 6 months. Anti-HBc may be the only marker of a recent HBV infection detectable following the disappearance of HBsAg, and prior to the appearance of anti-HBs, ie, window period.
Hepatitis C:
Hepatitis C antibody is usually not detectable during the early months following infection and is almost always detectable by the late convalescent stage of infection. Hepatitis C antibody is not neutralizing and does not provide immunity.
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 in Special Instructions:
-Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Clinical Reference
1. Roque-Afonso AM, Desbois D, Dussaix E: Hepatitis A virus: serology and molecular diagnostics. Future Virology. 2010;5(2):233-242
2. de Paula VS: Laboratory diagnosis of hepatitis A. Future Virology. 2012;7(5):461-472
3. Bonino F, Piratvisuth T, Brunetto MR, Liaw YF Diagnostic markers of chronic hepatitis B infection and disease. Antivir Ther. 2010;15(Suppl. 3):35-44
4. Wasley A, Fiore A, Bell BP: Hepatitis A in the era of vaccination. Epidemiol Rev. 2006;28:101-111
5. American Association for the Study of Liver Diseases/Infectious Diseases Society of America/International Antiviral Society-USA: Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed September 29, 2020. Available at www.hcvguidelines.org/contents
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;156:355-368. doi: 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. 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) 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 |
|---|---|---|---|
| HBGNT | HBs Antigen Confirmation, S | No | No |
| HCVQN | HCV RNA Detect/Quant, S | Yes | No |
Forms
If not ordering electronically, complete, print, and send 1 of the following:
mml-hepatitis