What laboratory tests are recommended for Hepatitis (inflammation of the liver) screening?

From the Guidelines

For hepatitis screening, I recommend ordering a comprehensive panel that includes hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb) IgG, and hepatitis C antibody (anti-HCV), as these tests are essential for identifying active and chronic infections, as well as previous exposure. According to the NCCN clinical practice guidelines in oncology 1, an appropriate hepatitis panel should include these tests to assess hepatitis B and C infection status. The HBsAg test identifies active hepatitis B infection, while the HBcAb IgG test indicates previous or ongoing infection. If the HBsAg is positive, further testing for HBeAg, HBeAb, and quantitative HBV DNA is necessary, and referral to a hepatologist is recommended 1. For hepatitis C, a positive antibody test should be followed up with quantitative HCV RNA and HCV genotype testing, also with referral to a hepatologist 1.

When interpreting test results, it is crucial to consider the clinical context and risk factors. For instance, an isolated HBcAb IgG may still indicate chronic HBV, prompting further testing for quantitative HBV DNA 1. Additionally, liver function tests (such as ALT, AST, bilirubin, and alkaline phosphatase) may be necessary to assess liver damage, particularly in cases of suspected acute hepatitis or abnormal liver tests of unknown cause.

Key components of the hepatitis screening panel include:

• Hepatitis B surface antigen (HBsAg)
• Hepatitis B core antibody (HBcAb) IgG
• Hepatitis C antibody (anti-HCV) These tests provide essential information for diagnosing and managing hepatitis infections, allowing for timely referral to a hepatologist and appropriate treatment. The NCCN guidelines emphasize the importance of a comprehensive hepatitis panel for accurate diagnosis and treatment planning 1.

From the Research

Hepatitis Screening Labs

To screen for hepatitis, the following labs can be ordered:

• HBsAg (hepatitis B surface antigen) 2, 3, 4, 5
• Anti-HBs (antibody to hepatitis B surface antigen) 2, 3, 5
• HBeAg (hepatitis B e-antigen) 2, 3, 5
• Anti-HBe (antibody to hepatitis B e-antigen) 2, 3, 5
• Anti-HBc (antibody to hepatitis B core antigen) 2, 3, 4, 5
• IgM anti-HBc (immunoglobulin M antibody to hepatitis B core antigen) 2, 3, 5
• HBV DNA (hepatitis B virus DNA) 2
• Anti-HCV (antibody to hepatitis C virus) 2, 5
• HCV RNA (hepatitis C virus RNA) 2
• HCV genotyping 2

Additional Labs

In certain situations, additional labs may be necessary, such as:

• Anti-HAV IgG/anti-HAV total (antibody to hepatitis A virus) 5
• Anti-HAV IgM (immunoglobulin M antibody to hepatitis A virus) 5
• HIV Ag/Ab (human immunodeficiency virus antigen/antibody) 5

Interpretation of Results

The interpretation of hepatitis screening labs can be complex and may require consideration of multiple factors, including:

• The presence or absence of specific viral markers 2, 3, 4, 5
• The levels of viral markers, such as HBsAg and anti-HBc 3, 4
• The presence of mutations in viral genes, such as the precore mutation in HBV 2
• The results of additional labs, such as HCV genotyping 2