What labs should be ordered for a hepatitis panel?

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Standard Hepatitis Panel Laboratory Tests

A standard hepatitis panel should include hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV), hepatitis B core antibody (anti-HBc), hepatitis B surface antibody (anti-HBs), and liver function tests including ALT, AST, ALP, GGT, bilirubin, and albumin. 1

Core Hepatitis Panel Components

Viral Hepatitis Markers

  • Hepatitis B testing:

    • Hepatitis B surface antigen (HBsAg)
    • Hepatitis B surface antibody (anti-HBs)
    • Hepatitis B core antibody (anti-HBc)
    • If HBsAg positive: Hepatitis B e antigen (HBeAg) and antibody (anti-HBe)
    • If HBsAg positive: HBV DNA quantification

  • Hepatitis C testing:

    • Hepatitis C antibody (anti-HCV)
    • If anti-HCV positive: HCV RNA PCR for confirmation

  • Additional viral hepatitis markers (when clinically indicated):

    • Hepatitis A antibody (IgM anti-HAV for acute infection, IgG anti-HAV for immunity)
    • Hepatitis D antibody (anti-HDV) in HBsAg-positive patients

Liver Function and Assessment Tests

  • Alanine aminotransferase (ALT)
  • Aspartate aminotransferase (AST)
  • Alkaline phosphatase (ALP)
  • Gamma-glutamyl transpeptidase (GGT)
  • Total and direct bilirubin
  • Albumin
  • Prothrombin time/INR

Expanded Testing Based on Initial Results

When initial testing reveals abnormal liver blood tests, the following additional tests should be considered 1:

Autoimmune Markers

  • Anti-mitochondrial antibody
  • Anti-smooth muscle antibody
  • Antinuclear antibody
  • Serum immunoglobulins (IgG, IgA, IgM)

Metabolic and Other Tests

  • Serum ferritin and transferrin saturation (to evaluate for hemochromatosis)
  • Alpha-1-antitrypsin level (when appropriate)
  • Ceruloplasmin (in patients aged 3-40 years)

Imaging

  • Abdominal ultrasound to assess liver morphology and rule out biliary obstruction

Interpretation of Key Hepatitis Markers

Hepatitis B Serologic Patterns

  • Current HBV infection: HBsAg positive, anti-HBc positive
  • Past resolved HBV infection: HBsAg negative, anti-HBs positive, anti-HBc positive
  • Vaccine-induced immunity: HBsAg negative, anti-HBs positive, anti-HBc negative
  • Chronic hepatitis B: HBsAg positive for >6 months

Hepatitis C Serologic Patterns

  • Current HCV infection: Anti-HCV positive, HCV RNA positive
  • Past resolved HCV infection or false positive: Anti-HCV positive, HCV RNA negative

Special Considerations

Pediatric Testing

For children, the hepatitis panel should be modified 1:

  • Ferritin and transferrin saturation may not be indicated
  • Autoantibody panel should include anti-liver kidney microsomal antibody
  • Alpha-1-antitrypsin level and ceruloplasmin (age >3 years) should be included

High-Risk Groups

For patients with risk factors (injection drug use, birth in endemic regions, etc.), consider:

  • More frequent testing
  • Testing for HIV co-infection
  • Testing for hepatitis D in those with hepatitis B 2

Clinical Pitfalls to Avoid

  • Don't repeat the same abnormal tests without investigating the cause - 75% remain abnormal even after 2 years 1
  • Don't miss occult hepatitis B - consider HBV DNA testing in patients with isolated anti-HBc positivity
  • Don't overlook hepatitis D in patients with hepatitis B, as co-infection accelerates disease progression 3
  • Don't forget to test for hepatitis A immunity in patients younger than 50 years with other forms of viral hepatitis 1
  • Don't miss autoimmune overlap syndromes which may require testing for multiple autoantibodies 4

By following this comprehensive hepatitis panel approach, clinicians can effectively diagnose viral hepatitis, assess disease severity, and guide appropriate management decisions to reduce morbidity and mortality from chronic liver disease.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Hepatitis C Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Hepatitis D: A Review.

JAMA, 2023

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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