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Viral Hepatitis Screening and Diagnosis (HAV, HBV, HCV)

CPT: 86704; 86706; 86708; 86803; 87340

Synonyms

  • Hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C

Test Includes

Hepatitis A Virus (HAV) Antibody, Total with reflex to IgM [144226]; Hepatitis B Virus (HBV) Screening and Diagnosis [144473]; Hepatitis C Virus (HCV) Antibody with reflex to Quantitative Real-time PCR [144050]


Special Instructions

If reflex test is performed, additional charges/CPT code(s) may apply.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.


Related Documents


Specimen Requirements


Specimen

Serum or EDTA plasma


Volume

11 mL


Minimum Volume

5.4 mL


Container

Gel-barrier tube; serum transfer tube; plasma transfer tube


Collection

Two samples must be submitted.

Antigen/antibody assays: If tube other than a gel-barrier tube is used, transfer separated serum/plasma to a plastic transport tube.

HCV RNA, quantitative: Centrifuge sample within 24 hours of collection. Transfer serum/plasma to a screw-cap polypropylene transport tube. Ship frozen (preferred). Plasma from a PPT can be frozen and shipped in situ. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit a separate frozen specimen for each test requested.


Storage Instructions

Refrigerated (preferred).

Antigen/antibody assays: stable 14 days at room temperature, refrigerated (preferred), and frozen.

HCV RNA: stable 24 hours at room temperature, 3 days refrigerated or 6 weeks frozen (preferred).


Causes for Rejection

Heat-inactivated specimens; cord blood; cadaveric specimens; body fluids other than serum or EDTA plasma; gross hemolysis; excessive lipemia; improper labeling


Test Details


Use

Aid in the diagnosis of viral hepatitis due to infection with HAV, HBV, and/or HCV.


Limitations

The assays in this panel have not been FDA cleared or approved for the screening of blood or plasma donors. Assay performance characteristics have not been established for immunocompromised or immunosuppressed patients, cord blood, or patients less than 2 years of age.


Methodology

Immunochemiluminometric assay (ICMA)


Additional Information

HAV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNI

Interpretation

HAV Ab, Total

HAV Ab, IgM

Susceptible/no indication of infection

-

TNI

Previously vaccinated against or infected with HAV

+

-

Acute infection

+

+

HBV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNI

Interpretation

HBsAg

anti-HBs

anti-HBc

IgM anti-HBc

* Multiple possibilities: resolved infection (most common); false-positive anti-HBc (susceptible); "low-level" chronic infection; resolving acute infection.

HCV Serology Interpretation: Key - Analyte present: + Analyte absent: - Test not indicated: TNI

Interpretation

HCV Ab

HCV RNA, NAA

*For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody should be performed. For persons who are immunocompromised, testing for HCV RNA should be performed.

**Repeat HCV-RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease.

No HCV antibody detected, no indication of infection*

-

TNI

HCV antibody detected but no evidence of current infection**

+

-

HCV antibody and viral RNA detected consistent with current infection

+

+

Susceptible/no evidence of infection

-

-

-

TNI

Immune due to natural resolved infection

-

+

+

TNI

Immune due to vaccination

-

+

-

TNI

Acute infection

+

-

+

+

Chronic infection

+

-

+

-

Intrepretation unclear*

-

-

+

±


References

Abara WE, Oaseem A, Schillie S. McMahon BJ, Harris AM, High Value Care Task Force of the American College of Physicians and the Centers for Disease Control and Prevention. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017 Dec 5;167(11):794-804.29159414
American Association for the Study of Liver Diseases, Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C: HCV Testing and Linkage to Care. HCVGuidelines.org web site: https://www.hcvguidelines.org/evaluate/testing-and-linkage. Accessed June 2021.
Centers for Disease Control and Prevention. Hepatitis B. CDC web site: www.cdc.gov/hepatitis/hbv/index.htm. Accessed May 2021.
Terrault NA, Lok ASF, McMahon BJ, et al. Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance. Hepatology. 2018 Apr;67(4):1560-1599.29405329
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137.26042815

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