Diagnosis of Hepatitis B Virus Infection (HBV) and Interpretation of HBV Serology

by Carlo Raj, MD

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    00:01 As I've told you, what our focus would be here with Hepatitides of viral type will be diagnosis.

    00:08 Let’s begin.

    00:10 You’ll notice that the symptoms are taking place on the X axis.

    00:13 We have months after infection.

    00:16 I want you to begin approximately two months here.

    00:19 So, approximately 2 to 4 months, the patient is having symptoms.

    00:21 What kind of symptoms this would be? For the most part, jaundice.

    00:26 Okay, jaundice.

    00:27 Remember anything beyond four weeks of hepatitis B, You usually wouldn't find your jaundice.

    00:33 As the gray shaded box is illustrating.

    00:39 Let's continue.

    00:41 What is viral hepatitis? Which transaminases are elevated more so? ALT? I want you to focus on the red line here and see where it has peaked? ALT should be your focus when dealing with Viral Hepatitis.

    00:58 Next, we'll take a look at the others, we have green, which is the green which is the IgG.

    01:05 And we have IgM.

    01:06 At this point, I want you to focus on IgM.

    01:10 You know that IgM is the first immunoglobulin to appear anytime there is infection Immediate, if that helps you-IgM.

    01:18 Eventually, that IgM is replaced by what kind of immunoglobulin? That would be IgG.

    01:24 These things, in terms of switching and such these discussions take place in immunology I’m just giving a quick review here.

    01:32 So that you can quickly give a diagnosis of a patient with hepatitis B.

    01:36 Next.

    01:37 There are different kinds of hepatitis B surface antigen, E antigens, and DNA.

    01:42 And those all play a role in for the most part in descending order.

    01:46 The Hepatitis surface antigen shows up a little bit later.

    01:49 E antigen shows up quite early And the HBV DNA will show up extremely early.

    01:56 You will notice that we have the yellow line.

    01:58 and the gold line which is your anti-hepatitis (HBe) And then you have your anti-hepatitis B surface antigen And that then shows up at the very end and that is your blue curve.

    02:09 Your focus here, should be in that gray shaded area.

    02:12 In which you are able to quickly diagnose your patient with hepatitis B.

    02:19 Interpretation of your table here.

    02:22 This is once again for your hepatitis B specifically.

    02:25 That’s your topic for the entire table.

    02:27 and on the top are the different types of components of Hepatitis B depending on what's going on in your patient.

    02:34 Let's begin with the interpretation at the far end of the table, And your focus would be acute infection or perhaps, reactivation.

    02:44 So which one of these markers are you going to find? Early, acute.

    02:49 Hepatitis B surface antigen I told you, shows up quite early in the symptomatic period.

    02:54 Anti-HBS, no. Negative. That shows up later on.

    02:58 In order for this table to make perfect sense, I recommend that you take a look back at the graph that we've just discussed.

    03:05 So that you have a visualization, As to the journey or the time course of hepatitis B.

    03:11 And you also have a table in which it speaks to And then listen to me, so that we can all reinforce this information And at some point in time, I'll come back to you, very quickly.

    03:22 We have anti-hepatitis B core IgM.

    03:27 IgM is the first immunoglobulin to show up thus, positive and acute.

    03:32 And we have hepatitis B-E antigen this DNA if all possible, you'll find this very early early early.

    03:39 This represents acute.

    03:42 Understood? Let's go on to prior infection with immunity.

    03:47 If you're thinking about prior infection, what kind of immunoglobulin should you be jumping to Good. IgG.

    03:55 You will notice here that Anti-HBc IgG is possible.

    03:59 That’s where your focus should be in, prior infection. Why why why? Anytime there is prior infection, the type of immunoglobulin that all you then are going to have chronically, will be IgG.

    04:10 Obviously anti-HBs would be positive.

    04:12 HBE may or may not be found but your focus here should be on IgG.

    04:18 What about vaccination with immunity? Well, with immunity and vaccination, we still might find anti-HBs way down the line.

    04:26 That that represents vaccination.

    04:29 Let's do chronic HBV, this is a carrier patient; carrier.

    04:36 So, what is the patient now carrying? It will be HBs as you can expect.

    04:43 What kind of immunoglobulin It would be IgG.

    04:48 Hepatitis B and carrier you will notice, you have anti-HBe Here the viral account for HBV DNA will less than 20,000 but not as high as you find in an acute, it is still present, why? Your patient is state of chronic carrier state.

    05:04 Your patient is in a state of chronic carrier state.

    05:09 Next, we have e Anti-positive chronic hepatitis B In this thing here is dangerous, dangerous.

    05:16 You find a couple things here.

    05:18 Your focus should be once again IgG, hepatitis B surface antigen same on which you found earlier with chronic carriers.

    05:25 Here there is going to be e Antigen present but this is difficult.

    05:29 For the patient and for you because you have a great number of HBV DNA.

    05:36 Active? Extremely. Chronic? Yes.

    05:40 e Antigen not good in terms of whether or not the patient is able to pass it on to, his or her partner.

    05:48 And finally, we have e Antigen negative, chronic Hepatitis B, anything that you find here, is the fact that you have anti HBV DNA At this point is e Antigen negative.

    06:01 In terms of viral count it will still be greater than 20,000.

    06:05 Interpretation is where your focus will be at first, then you take a look at the various markers, we interpet as such, and then go back and take a look at the graph so that you will be able to understand the timeline.

    About the Lecture

    The lecture Diagnosis of Hepatitis B Virus Infection (HBV) and Interpretation of HBV Serology by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.

    Included Quiz Questions

    1. 2 to 4 months
    2. 0 to 2 months
    3. 4 to 6 months
    4. 1 to 2 years
    5. 2 to 4 years
    1. IgM Anti-HBc
    2. IgG-Anti HBc
    3. Anti HBe
    4. Anti HBs
    5. HBsAg
    1. Anti HBs
    2. Anti HBe
    3. IgM Anti HBc
    4. IgG Anti HBc
    5. HbsAg
    1. The patient had a prior infection of hepatitis B
    2. The patient is having an acute infection of hepatitis B
    3. The patient had a prior vaccination for hepatitis B
    4. The patient is a chronic hepatitis B carrier
    5. The patient has a chronic hepatitis B infection
    1. Anti Hbs positive
    2. HbsAg, Anti HBc IgM and HbeAg are positive
    3. HBsAg, Anti HBc IgG and Anti HBeAg are positive and HBV DNA is less than 20000 copies
    4. HBsAg, Anti HBc IgG and HBeAg are positive and HBV DNA is more than 20000 copies
    5. Anti HBs and Anti HBc IgG
    1. Defer collection of blood from this donor
    2. Collect the blood and use the blood for transfusion
    3. Ask him to return when his serology shows positive for Anti HBc IgG and Anti HBe
    4. Advise him to consult a gastroenterologist
    5. Advise him to repeat serology testing 6 months later and donate blood

    Author of lecture Diagnosis of Hepatitis B Virus Infection (HBV) and Interpretation of HBV Serology

     Carlo Raj, MD

    Carlo Raj, MD

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    the tutor did a great job
    By ARIBA F. on 29. June 2017 for Diagnosis of Hepatitis B Virus Infection (HBV) and Interpretation of HBV Serology

    the tutuor did a great job but i find this topic diffucult and did not get a clear picture of it yet