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Test ID: HBPES Hepatitis B Virus Past Exposure Panel, Serum


Necessary Information


Date of collection is required.



Specimen Required


Collection Container/Tube: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 1.5 mL

Collection Instructions:

1. Centrifuge blood collection tube per collection tube manufacturer's instructions (eg, centrifuge and aliquot within 2 hours of collection for BD Vacutainer tubes).

2. Aliquot serum into plastic vial.


Useful For

Screening for past exposure to hepatitis B virus (HBV)

 

Determining HBV infection status prior to initiating chemotherapy or other immunosuppressive therapies

Profile Information

Test ID Reporting Name Available Separately Always Performed
HBGSN HBs Antigen Scrn, S Yes Yes
HBCSN HBc Total Ab Scrn, S Yes Yes
HBBSN HBs Antibody Scrn, S Yes Yes

Testing Algorithm

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

 

See Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management

Method Name

Chemiluminescence Immunoassay (CIA)

Reporting Name

Hepatitis B Past Exposure, S

Specimen Type

Serum SST

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum SST Frozen (preferred) 28 days
  Refrigerated  7 days
  Ambient  24 hours

Clinical Information

Hepatitis B is a DNA viral infection that is endemic throughout the world. The hepatitis B virus (HBV) is transmitted parenterally or percutaneously from exposure to contaminated blood, blood products, or injection needles, sexually from exposure to body fluids from infected individuals, or perinatally from mother to child during birth delivery by contact with infected mother's blood and vaginal secretions. Transplacental transmission from mother to fetus is uncommon.

 

HBV persists and causes chronic infection (defined as being positive for hepatitis B virus surface antigen [HBsAg] in serum or plasma for minimum 6 months) in about 10% of individuals who had acute infection during childhood. These individuals may become asymptomatic HBV carriers (ie, inactive chronic hepatitis B), while others may develop chronic liver diseases including cirrhosis and hepatocellular carcinoma. Asymptomatic HBV carriers are at risk (up to 50%) for decompensation of liver function with acute HBV replication (ie, HBV reactivation) during immunosuppression from chemotherapy, immunosuppressive therapy, or organ transplantation.

 

Individuals who recovered from acute hepatitis B (defined as being negative for HBsAg, positive for total HBV core antibodies, negative or positive for HBV surface antibody) are lower risk (up to 20%) of HBV reactivation than those with inactive chronic hepatitis B during immunosuppressive therapy or organ transplantation.

 

For individuals born in regions of the world where HBV prevalence is moderate to high, universal HBV serologic screening before initiation of immunosuppressive therapy is recommended. In the absence of systematic, risk-based testing, universal HBV serologic screening is an option to reduce the risk of missing persons with HBV infection prior to initiation of immunosuppressive treatment.

Reference Values

Negative

See Viral Hepatitis Serologic Profiles in Special Instructions.

Interpretation

Hepatitis B virus surface antigen (HBsAg) is the first serologic marker appearing in blood 6 to 16 weeks after exposure to hepatitis B virus (HBV). A confirmed positive HBsAg result is indicative of acute or chronic hepatitis B. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6-months duration indicates development of either a chronic carrier state or chronic hepatitis B.

 

Hepatitis B virus surface antibody (HBsAb) appears with the resolution of HBV infection and disappearance of HBsAg. A positive result indicates recovery from acute or chronic hepatitis B or acquired immunity from HBV vaccination. This assay does not differentiate between a vaccine-induced immune response and recovery from HBV infection. Per assay manufacturer's instructions for use, positive results are defined as HBsAb levels of 12.0 mIU/mL or greater, with adequate immunity to hepatitis B after recovery from past infection or HBV vaccination. Per current CDC guidance, individuals with HBsAb levels of 10 mIU/mL or greater after completing an HBV vaccination series are considered protected from hepatitis B.

 

Negative HBsAb results (levels of < 5.0 mIU/mL) indicate a lack of recovery from acute or chronic hepatitis B or inadequate immune response to HBV vaccination.

 

Indeterminate results (HBsAb levels in the range of 5.0 to 11.9 mIU/mL) indicate inability to determine if HBsAb is present at levels consistent with recovery or immunity. Repeat testing is recommended in 1 to 3 months.

 

Hepatitis B virus core (HBc) total antibodies (combined IgG and IgM) appear shortly after the onset of symptoms of HBV infection and may be the only serologic marker remaining years after exposure to HBV. A positive result indicates exposure to HBV infection. A positive HBsAb result along with a positive HBc total Ab result is indicative of recovery from HBV infection. A positive HBsAb result with a negative HBc total Ab result is consistent with immunity to hepatitis B from HBV vaccination.

 

Summary of interpretation of the various HBV serologic test result profiles is provided in the table below:

 

HBV serologic test results

Interpretation

HBsAg

HBc total Ab

HBsAb

+

+

-

Chronic hepatitis B

-

+

+

Past HBV infection (resolved)

-

+

-

Past HBV infection, resolved or false-positive

-

-

+

Immune (from HBV vaccination)

-

-

-

Uninfected (not immune)

Clinical Reference

1. Schillie S, Vellozzi C, Reingold A, et al: Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018 Jan 12;67(1):1-31. doi: 10.15585/mmwr.rr6701a1

2. Centers for Disease Control and Prevention (CDC), Division of Viral Hepatitis: Interpretation of hepatitis B serologic test results. CDC; Accessed January 4, 2021. Available at www.cdc.gov/hepatitis/HBV/PDFs/SerologicChartv8.pdf

3. Terrault NA, Lok ASF, McMahon BJ, et al: Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-1599

Day(s) Performed

Monday through Saturday

Report Available

Same day/1 to 3 days

Test 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

86706

86704

87340

G0499 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HBPES Hepatitis B Past Exposure, S 77190-7

 

Result ID Test Result Name Result LOINC Value
HBCSN HBc Total Ab Scrn, S 13952-7
HBAGS HBs Antigen Scrn, S 5196-1
HBASN HBs Antibody Scrn, S 10900-9
HBSQN HBs Antibody, Quantitative, S 5193-8
Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information:

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