Hepatitis serology

Evaluate hepatic serologies to diagnose the type of hepatitis infection a patient acquired. 

TABLE 21-2. Interpretation of Viral Hepatitis Serology Panels... 

In the case of non-dilated bile ducts, further specific laboratory parameters may be necessary for differential diagnosis, such as electrophoresis, immunoglobulins, hepatitis serology (s. p. 116) and tti-foetoprotein (s. p. 106). Determination of the AMA should always be considered. (s. p. 120) (s. tabs. 5.19-5.21 13.7)... 

A.G. Acute delta hepatitis serological diagnosis with particular reference to hepatitis delta virus RNA. Amer. J. Gastroenterol. 1991 86 ... 

A 47-year-old woman was given exemestane 25 mg daily and after 3 weeks reported fatigue, jaundice, and pruritus, associated with rises in total bilirubin, aminotransferases, and alkaline phosphatase. Hepatitis serology, including hepatitis A IgM, hepatitis B surface antigen, hepatitis B core IgM, and hepatitis C antibody, was negative, as were autoantibodies associated with autoimmune hepatitis. 

Diagnosing viral hepatitis may be difficult because most infected individuals are asymptomatic. Because symptoms cannot identify the specific type of hepatitis, laboratory serologies must be obtained (Table 21-2). In addition, liver function tests may be obtained to assess the extent of cholestatic and hepatocellular injury. However, the definitive test to determine the amount of damage and inflammation of hepatic cells is a liver biopsy. 

In patients with either HBeAg-positive or HBeAg-negative hepatitis B, monitor hepatitis B serologies and HBV DNA levels every 3 months to determine treatment response regardless of the therapy given.28,32... 

The practicing clinician has a number of different tests available to aid in the evaluation of patients with suspected hepatitis C. These include measurement of alanine aminotransferase (ALT) levels, liver biopsy, serological tests (ELISA and recombinant immunoblot assay), and molecular methods for detection and quantitation of HCV RNA. 

TABLE 25-4 Interpretation of Serologic Tests in Hepatitis B Virus ... 

From Centers for Disease Control and Prevention Hepatitis B Serology, httpy/wmv.cdc.gov/nddod/diseases/hepalilis/b/Bserology.htm. 

The activity of AST and ALT had by this time passed their peak but the bilirubin concentration was elevated, often good signs that the acute condition is beginning to reside. Viral serology provided definitive evidence of hepatitis B infection this is not uncommon in conditions where sanitation is rudimentary. The patient made a full recovery about 4 months after diagnosis, but was advised to abstain from alcohol for several more months. 

Hepatomegaly, jaundice, and altered liver function tests have been reported in accidental poisonings with DME An outbreak of toxic liver disease was associated with DME exposure at a fabric coating factory. Thirty-six of 58 workers had elevations of either aspartate aminotransferase or alanine aminotransferase. Serological tests excluded known infectious causes of hepatitis in all but two cases. After modification of work practices and removal of the most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms occurred in most patients. Medical surveillance of the working population for 14 months revealed no further cases of toxic liver... 

Another patient taking acarbose also had a serum alanine transaminase three times the upper limit of the reference range, but she had positive serology for hepatitis A (21). 

A 65-year-old woman developed fatigue, jaundice, and altered liver function tests while taking atorvastatin (20 mg/day for some weeks) (14). On the basis of clinical, serological, and histological findings, a diagnosis of autoimmune hepatitis was made. 

Cholestatic hepatitis developed in a 71-year-old man with nephrotic syndrome (2). Hepatic function was normal after several months of fluvastatin 20 mg/day. Some weeks after the dose was increased to 40 mg/day, his gamma-glutamyl transpeptidase activity rose from normal to 1818 IU/1, with negative serology for viruses. After normalization, re-introduction of fluvastatin 20 mg/day was not tolerated, but he did tolerate simvastatin 20 mg/day. 

Healthy male subjects, aged 18-45 years (inclusive), with a Body Mass Index between 18 and 27 kg/m2 (inclusive), normal or clinically irrelevant abnormal findings (in the opinion of the investigator) in the medical history and physical examination, laboratory values, ECG, blood pressure and pulse rate, negative serology (HIV antibody, hepatitis B surface antigen, hepatitis C antibody) and urine screen for drugs of abuse. 

Causes of cirrhosis can usually be identified by the patient s history combined with serological and histological investigation. Alcoholic liver disease and hepatitis C and B are the most common causes of cirrhosis. The association of excessive alcohol consumption with liver disease has been recognised for centuries. After the identification of the hepatitis C vims and of non-alcoholic steatohepatitis in obese patients with diabetes, the diagnosis of cirrhosis without an apparent cause (cryptogenic cirrhosis) is rarely made. Genetic causes of cirrhosis include haemochromatosis and Wilson s disease. 

A 38-year-old white woman was found dead (15). She had physical evidence of previous drug abuse and positive hepatitis B and C serology. Her plasma clonazepam concentration was 1.41 pg/ml and her plasma oxycodone concentration was 0.60 pg/ml. 

Chronic hepatitis C Viral infection causes inflammation and low-grade damage that can lead to cirrhosis. Can be diagnosed with serologic assays for hepatitis C antibody or viral RNA. 

Young (<50 years) and no other cause found past history or family history of venous thrombosis, especially if unusual site (cerebral, mesenteric, hepatic veins) recurrent miscarriage thrombocytopenia cardiac valve vegetations livedo reticularis raised ESR malaise positive syphilis serology... 

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