Hepatitis B Fact Sheet - HCV Advocate

1 Hepatitis B fact Sheet B V. H. A Publication of the Hepatitis C Support Project a series of fact sheets written by experts in the field of liver disease Written by: Tim Teeter, RN, and Alan Franciscus, Editor-in-Chief HCSP Publications How to Interpret (and Understand). Liver Tests I t is important for people chronically infected with the Hepatitis B virus (HBV) to regularly monitor the health of their liver, usually through lab tests performed on a blood sample. The tests analyze a variety of en- More HBV Tests: There are many different types of diagnostic tests that are dis- zymes and other substances, which provide a report card on the health cussed in more detail in other of a liver.

2 HBV fact Sheets: Hepatitis B antigens are pro- These tests should be conducted every three, six, or 12 months at a teins that make up different parts minimum, and more frequently if there is liver damage and/or the person of the virus. Several diagnostic tests measure the presence of is undergoing treatment. The test results can be confusing, below is an specific antigens. explanation of some of these key lab tests. Antibodies are substances pro- duced by the body to fight a viral Alpha fetoprotein (AFP) is not part of liver function tests, but infection.

3 Hepatitis B antibody tests are used to stage infection doctors order this test along with liver enzyme tests, because and to find out if the body has an increase in AFP can indicate the presence of a liver tumor or resolved or cleared the Hepatitis B viral infection. cancer caused by Hepatitis B. HBV DNA is the genetic mate- rial that makes up the virus and Lab test results (in addition to viral load or HBV-DNA levels), how long is used for several diagnostic tests. a person has been infected, and age will help determine whether treat- Liver biopsy is a procedure in ment is recommended, or if a liver biopsy is needed to reveal more which a sample of liver tissue is detailed information about the health of the liver.

4 Taken for laboratory examination. Liver biopsies are used to moni- It is important to be pro-active and obtain and maintain a file of all lab tor liver disease progression in people with Hepatitis B. reports in order to manage one's health and make informed treatment decisions. Lab results can also vary from one lab to another, so blood samples should always be sent to the same lab in order to get consis- tent lab test results over months and years when important treatment choices are made. Hepatitis B fact Sheet HBV fact Series 2.

5 Liver Tests is inflammed or develops scar nesses. Some medications may Liver Biochemical/ tissue, such as during a child's also cause increased levels. Function Tests immune tolerant stage of HBV Normal ranges are 44 to 147. Alanineaminotransferase(ALT), infection when the immune sys- IU/L. previously called SGPT, is an tem has not noticed the infection enzyme produced by liver cells and begun attacking infected Gamma-glutamyl transpep- (hepatocytes). The level of ALT liver cells. Some HBV-infected tidase (GGT or GGPT) is also in the blood increases when liv- adults and children with normal an enzyme produced in the bile er cells are damaged or die at ALT levels have been known ducts that may be elevated in higher rates than normal.

6 The to develop liver damage. That people with bile duct diseases. more liver cells that are dam- is why it is important to have a Hepatitis and heavy alcohol con- aged, the higher the ALT level variety of tests to assess liver sumption also increase GGT. may be. Drugs, alcohol use, health. Normal ranges are 0 to 51. some over-the-counter pain- IU/L. killers, toxins, viruses herbs, Normal ALT levels are com- and other substances can also monly reported as 0-30 IU/L. Bilirubin is the major breakdown cause abnormal increases in (international units per liter) for product of old red blood cells.

7 ALT levels. men and 0-19 IU/L for women. Hemoglobin is released from the Normal ALT levels for children red blood cells; the heme por- However, ALT levels are not al- and teens are generally about tion is further broken down into ways true indications of how 30 IU/L, or whatever a lab iden- bilirubin. When liver function is healthy a liver is. An ALT level tifies as the upper limit of nor- impaired, as with acute Hepatitis shows only the condition of liver mal. Physicians rely heavily on or end stage liver disease, bili- cells on the day the blood was ALT levels and viral load when rubin accumulates in the blood drawn for the test.

8 Liver cell deciding whether to prescribe and causes yellowing of the skin damage and spikes in ALT lev- treatment. and eyes, called jaundice. With els may have been occurring, HBV infection, bilirubin levels are but unless a person had a blood Aspartate aminotransferase usually normal until a significant test on the day of the spike, it (AST), previously called SGOT, amount of liver damage has oc- would never be documented or is an enzyme similar to ALT but curred. Bilirubin is often report- known. Recently, researchers is less specific for liver disease.

9 Ed as total, indirect (the amount are finding that when HBV pa- In many cases of liver inflamma- of unconjugated bilirubin or tients with normal ALT levels tion, the ALT and AST levels are free bilirubin that has not been have their liver enzymes tested elevated. attached to a glucuronide mol- weekly or monthly, they indeed The normal range for AST is ecule), and direct (the amount do have increases in their ALT 10 to 34 IU/L. of conjugated bilirubin or bili- levels. rubin that has been chemically Alkaline phosphotase is an en- attached to a glucuronide in the Only a liver biopsy that extracts zyme produced in the bile ducts liver and then excreted from liv- a needle-sized sliver of liver tis- and the bone, and found in the er cells into the bile and stored sue can reveal the true condi- liver.)

10 Levels are increased in in the gallbladder or transferred tion of the liver. ALT levels can Hepatitis , cirrhosis, and other ill- to the duodenum). remain low even when the liver 3 HBV fact Series Hepatitis B fact Sheet Liver Tests Normal range of total bilirubin AFP, produced by the liver, is count is called neutropenia. is to mg/dL (milligrams more commonly measured to di- Interferon can also cause per deciliter). agnose fetal distress or fetal ab- neutropenia. Chemotherapy normalities in pregnant women. definitely causes neutropenia.