How to Order Hepatitis B Titer Testing
Order a three-test panel consisting of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and total hepatitis B core antibody (anti-HBc) to comprehensively assess hepatitis B status. 1
Standard Laboratory Order
The baseline serologic assessment for hepatitis B requires all three markers simultaneously: 1
- HBsAg - Identifies active infection (acute or chronic) 2, 1
- Anti-HBs (quantitative) - Indicates immunity from vaccination or past cleared infection 2, 1
- Total anti-HBc - Distinguishes natural infection from vaccine-induced immunity 2, 1
This three-test panel is recommended by the American Gastroenterological Association and CDC as the standard approach for all adults aged 18 years and older. 1
How to Write the Order
Request the following tests from your laboratory:
- "Hepatitis B surface antigen (HBsAg)" 2, 1
- "Hepatitis B surface antibody (anti-HBs), quantitative" - Specify quantitative to get a titer value in mIU/mL, not just positive/negative 1, 3
- "Hepatitis B core antibody, total (anti-HBc total)" - Specify "total" not "IgM" for screening 2, 1
Additional Tests Based on Clinical Context
For suspected acute infection, add IgM anti-HBc to distinguish acute from chronic infection. 2, 1
For confirmed chronic HBV (HBsAg positive >6 months), order: 2, 1
- HBeAg/anti-HBe to assess viral replication phase 2, 1
- HBV DNA quantitative (viral load) 2, 1
- ALT/AST to evaluate liver inflammation 2, 1
For immunocompromised patients or those starting immunosuppressive therapy, the same three-test panel (HBsAg, anti-HBs, anti-HBc) must be ordered before initiating therapy to stratify reactivation risk. 2, 1
Common Pitfalls to Avoid
Do not order only anti-HBs alone - This misses active infection (HBsAg) and cannot distinguish vaccine immunity from natural immunity (anti-HBc). 1, 3
Do not order IgM anti-HBc for routine screening - IgM anti-HBc is only for suspected acute infection, not for general titer checking. 2, 1
Specify quantitative anti-HBs - A quantitative result (in mIU/mL) is more useful than qualitative (positive/negative) for assessing adequacy of vaccine response, where ≥10 mIU/mL indicates protective immunity. 2, 3
Ensure confirmatory testing for positive HBsAg - Laboratories should use FDA-licensed tests and perform neutralizing confirmatory testing on initially reactive HBsAg specimens. 2