Can I order a hepatitis panel for a patient?

Ordering a Hepatitis Panel

Yes, you should order a hepatitis panel for patients with abnormal liver blood tests, suspected liver disease, or specific risk factors for viral hepatitis. 1

When to Order a Hepatitis Panel

Clinical Indications:

• Unexplained elevated liver enzymes (ALT, AST, alkaline phosphatase)
• Clinical jaundice
• Suspected acute or chronic viral hepatitis
• Evaluation of abnormal liver blood tests
• Pre-immunosuppressive therapy screening
• Workup for hepatobiliary cancers

Risk Factors Warranting Testing:

• History of injection drug use
• HIV infection
• Recipients of blood products or organ transplants before 1992
• Hemodialysis patients
• Healthcare workers with needlestick injuries
• Sexual partners of HBV/HCV-infected persons
• Persons born in regions with high HBV prevalence (>2%)
• Unexplained chronic liver disease

Components of a Comprehensive Hepatitis Panel

Hepatitis B Testing:

• Hepatitis B surface antigen (HBsAg)
• Hepatitis B surface antibody (HBsAb)
• Hepatitis B core antibody IgG (HBcAb IgG)
• If HBsAg positive: HBeAg, HBeAb, and quantitative HBV DNA 1, 2

Hepatitis C Testing:

• Hepatitis C antibody (anti-HCV)
• If positive: Reflex to HCV RNA quantitative testing 1, 2

Additional Testing to Consider:

• Hepatitis A antibody IgG (anti-HAV IgG) for immunity status
• Hepatitis D antibody (anti-HDV) if HBsAg positive
• HIV testing (due to common risk factors)

Clinical Pearls and Pitfalls

Important Considerations:

• An isolated HBcAb IgG positive result may still indicate chronic HBV and should prompt testing for quantitative HBV DNA 1
• HBcAb IgM should only be checked in cases of suspected acute viral hepatitis 1
• A positive HCV antibody test should automatically reflex to HCV RNA testing to confirm active infection 2
• Liver function tests (ALT, AST, bilirubin, albumin, INR) should accompany hepatitis testing to assess disease severity 1, 2

Pitfalls to Avoid:

• Don't rely solely on HBsAg for hepatitis B screening; include HBsAb and HBcAb for complete assessment 2
• Don't assume normal ALT excludes viral hepatitis, as levels may fluctuate or be normal in chronic infection 1
• Don't repeat the same panel of tests for abnormal liver blood tests without determining the cause 1
• Don't delay hepatitis testing in patients with risk factors, as early diagnosis improves outcomes

Follow-up Actions After Testing

• Refer patients with positive HBsAg or HCV RNA to a hepatologist 1
• Vaccinate non-immune patients against hepatitis A and B, especially those with chronic liver disease 2
• Counsel patients about preventing transmission if infected
• Consider additional testing for liver fibrosis in chronic infections

By following these guidelines, you can appropriately use hepatitis panel testing to identify viral hepatitis infections early, prevent complications, and improve patient outcomes.