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Test ID: PHEP Previous Hepatitis (Unknown Type), Serum


Necessary Information


Date of draw is required.



Specimen Required


Two aliquots of serum are required for testing: 0.5 mL of refrigerated serum and 2.5 mL of frozen serum.

 

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 (eg, centrifuge and aliquot within 2 hours of collection for BD Vacutainer tubes).

2. Aliquot 0.5 mL serum into a plastic vial labeled as HAIGG, and ship refrigerate (required)

3. Aliquot remaining 2.5 mL serum into a second plastic vial labeled as SST Serum, and ship frozen (preferred).


Useful For

Determining if an individual has been infected following exposure to an unknown type of hepatitis

 

Obtaining baseline serologic markers of an individual exposed to a source with an unknown type of hepatitis

 

Determining immunity to hepatitis A and B viral infections

Profile Information

Test ID Reporting Name Available Separately Always Performed
HAIGG Hepatitis A IgG Ab, S Yes Yes
HBAG HBs Antigen, S Yes Yes
HBAB HBs Antibody, S Yes Yes
HBC HBc Total 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 B surface antigen (HBsAg) is reactive, then HBsAg confirmation will be performed at an additional charge.

 

See the following:

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

-Hepatitis C: Testing Algorithm for Screening and Diagnosis

Method Name

HAIGG: Chemiluminescent Microparticle Immunoassay (CMIA)

HBAG, HBAB, HBC, HCVDX, HBGNT: Chemiluminescence Immunoassay (CIA)

Reporting Name

Previous Hepatitis Profile

Specimen Type

Serum
Serum SST

Specimen Minimum Volume

2.5 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 viral hepatitis in adults in the United States. HAV infection is spread by the oral/fecal route and produces acute hepatitis that 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 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 users). The virus is 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, while 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 close, personal contact. 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.

Reference Values

HEPATITIS B SURFACE ANTIGEN

Negative

 

HEPATITIS B SURFACE ANTIGEN CONFIRMATION

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 A IgG ANTIBODY

Unvaccinated: negative

Vaccinated: positive

 

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.

Interpretation

Hepatitis A:

Antibody against hepatitis A antigen (anti-HAV) is almost always detectable by the onset of symptoms (usually 15-45 days after exposure). The initial antibody consists almost entirely of the IgM subclass of antibody. Anti-HAV IgM usually falls to undetectable levels 3 to 6 months after infection. Anti-HAV IgG levels rise quickly once the virus is cleared and persist for many years.

 

Hepatitis B:

Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 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 appears as the immune response following a course of inoculation with the hepatitis B vaccine.

 

Hepatitis B core antibody (anti-HBc) appears shortly after the onset of symptoms of HBV infection and may be the only serologic marker remaining years after exposure to hepatitis B.

 

Hepatitis C:

Anti-HCV is usually not detectable during the early months following infection but is almost always detectable by the late convalescent stage of infection. Anti-HCV is not neutralizing and does not provide immunity.

 

Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles.

Clinical Reference

1. Roque-Afonso AM, Desbois D, Dussaix E: Hepatitis A virus: serology and molecular diagnostics. Future Virology. 2010 Mar;5(2):233-242

2. de Paula VS: Laboratory diagnosis of hepatitis A. Future Virology. 2012 May;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 and Infectious Diseases Society of America: HCV guidance: Recommendations for testing, managing, and treating hepatitis C. Accessed October 7, 2022. 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 Jul;161(1):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 Aug;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. Gastroenterology. 2019 Jan;156(2):355-368.e3. doi: 10.1053/j.gastro.2018.11.037

9. World Health Organization: WHO guidelines on hepatitis B and C testing. 2017. Accessed October 7, 2022. Available at www.who.int/hepatitis/publications/HEP17001_WEB11.pdf?ua=1

10. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention: Testing and public health management of persons with chronic hepatitis B virus infection. Centers for Disease Control and Prevention. Updated March 28, 2022. Accessed October 7, 2022. Available at www.cdc.gov/hepatitis/hbv/testingchronic.htm

Day(s) Performed

Profile tests: Monday through Friday; Reflex tests: Varies

Report Available

Same day/1 to 2 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

86704

86706

86708

86803

87340

87341 (if appropriate)

87522 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PHEP Previous Hepatitis Profile 92890-3

 

Result ID Test Result Name Result LOINC Value
HCVA4 HCV Ab, S 40726-2
HBC HBc Total Ab, S 13952-7
HB_AB HBs Antibody, S 10900-9
H_BAG HBs Antigen, S 5196-1
HAIGG Hepatitis A IgG Ab, S 40724-7
HBSQN HBs Antibody, Quantitative, S 5193-8

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:

-Gastroenterology and Hepatology Client Test Request (T728)

-Infectious Disease Serology Test Request (T916)

Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog Additional Information:

mml-hepatitis