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Clinical Indication HAMILTON REGIONAL MICROBIOLOGY LABORATORY PROTOCOL FOR VIRAL HEPATITIS TESTING Order Laboratory Tests Performed Comments Suspect acute hepatitis: nausea, vomiting, jaundice, anorexia and elevated ALT (at least 1.5 x normal). “Acute Hepatitis” Hepatitis A (Anti-HAV IgM) Hepatitis B (HBsAg) (Anti-HBc IgM) Suspect chronic hepatitis: previous history of elevated liver enzymes or liver cirrhosis or cancer. ALT normal or elevated. “Chronic Hepatitis” Hepatitis B (HBsAg) Hepatitis C (Anti-HCV) Does my patient have immunity to Hepatitis A? “Immune status, Hepatitis A” Anti-HAV IgG Does my patient have Immunity to Hepatitis B? “Immune status, Hepatitis B” Anti-HBs Needlestick injury: blood is obtained from the source to determine infectivity (often this is a patient). “Hepatitis Needlestick Source” HBsAg Anti-HCV “Hepatitis Needlestick Recipient” The laboratory will test for acute Hepatitis A and Hepatitis B. If both anti-HAV and HbsAg are negative, the specimen will automatically be tested for anti-Hepatitis B core IgM antibody (anti-HBc IgM). In an acute hepatitis B infection, anti-HBc IgM is detectable for a longer time than HbsAg (“window period”). Chronic hepatitis may or may not be symptomatic. Long-term complications include liver cirrhosis and liver cancer. ALT may or may not be elevated. The laboratory will test for Hepatitis B surface antigen as well as for Hepatitis C antibodies. If the HBsAg is positive for > 6 months, this is consistent with chronic Hepatitis B infection. If Anti-HCV is present, this is consistent with current or past infection. There is no test available at this time to distinguish between current and previous hepatitis C infection. To document immunity to hepatitis due to either natural infection or vaccination, please order “immune status” followed by either “Hepatitis A” or “Hepatitis B.” When a needlestick injury has occurred, please contact Employee Health Services at your hospital. Draw blood as soon as possible on both source and recipient. Cross-reference the source and recipient under “comments” when ordering the test. Anti-HBs Anti-HCV Other tests on request: HBsAg Anti HBc The blood samples are stored. If any of these additional hepatitis tests are required, please contact a Microbiologist. Hepatitis B core Antibody (Anti HBc) Hepatitis C RNA (Qualitative PCR) * Hepatitis E Virus** Hepatitis Be Antigen (HBeAg) Hepatitis C RNA (Quantitative PCR) * Hepatitis G Virus** Hepatitis Be Antibody (Anti Hbe) Hepatitis C Genotyping PCR * ** No testing available Hepatitis Delta Antibody (Anti HBD) Hepatitis B DNA PCR (HBV DNA) * * Requires new specimen Needlestick injury: blood is obtained from the recipient to determine susceptibility (often this is a health care worker). 08/11/17