The following tests should be ordered following a needle prick injury or accidental inoculation
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Contact the Occupational Health Nurse
Order the following tests:
HBsAg anti-HCV and anti HIV from the source patient
HBsAg anti-HBs anti-HCV and anti HIV from the injured staff member
The following tests should be ordered for the investigation of possible hepatitis:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests:
HBsAg
and then HBeAg - if the HBsAg test is positive
The following tests should be ordered for the investigation of possible hepatitis:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests every 6 months:
HBsAg
anti-HBs
anti-HCV
The following tests should be ordered for the investigation of possible hepatitis:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order HBsAg
Test performed by the Virology/Immunology laboratory.
For results, use ward computer or phone Lablink: 5995 or (09) 307-8995 or 0800 522 758.
The following tests should be ordered for the investigation of possible hepatitis A:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests:
anti-HAV (IgM)
anti-HAV total (IgM and IgG)
# Tests performed daily, STAT
GENERAL INFORMATION:
Hepatitis A is commonly transmitted via the faecal/oral route and has an incubation period of 3-6 weeks. It occurs throughout the year but tends to peak in Autumn. Clinical infection is usually abrupt in onset with symptomatic disease increasing with increasing age. Complications are uncommon and there is no chronic carriage. The mortality rate in icteric cases is < 0.5% overall.
Patients are infectious during the incubation period and for approximately one week after the development of jaundice.
Diagnosis of acute infection is by the detection of anti-HAV IgM antibodies.
The following tests should be ordered for the investigation of immunity to hepatitis A:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests:
anti-HAV total (IgM and IgG)
The following tests should be ordered as a pre-vaccination screen:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests:
HBsAg
anti-HBs
The following tests should be ordered as a post-vaccination screen:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following test:
anti_HBs
INTERPRETATION: Levels of anti-HBs > or = 10 IU/L are consistent with immunity.
Uncertainty of Measurement: 15%
The following tests should be ordered for the investigation of immunity to hepatitis B:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Order the following tests:
HBsAg
anti-HBs
Test performed by the Virology/Immunology laboratory.
For results, use ward computer or phone Lablink: 5995 or (09) 307-8995 or 0800 522 758.
The following tests should be ordered for the investigation of possible hepatitis B infection:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
Hepatitis B is an enveloped double-stranded DNA virus. It is estimated that 1-2% of the New Zealand population are carriers with an especially high carriage rate in Maori and Pacific Islanders. Transmission is via a number of routes, most importantly parenterally, sexually and vertically. The incubation period is long (approximately 6 weeks to 6 months).
Infection in neonates is usually sub-clinical. In children approximately 10% is clinical and adulthood approximately 30-50% clinical. Carriage rates are high when infection is acquired earlier in life (e.g. approximately 90% in childhood and probably <5% in adulthood). Mortality in icteric cases is <1-2%.
DIAGNOSIS:
Serological assays for diagnosis are based on the detection of circulating antigens and antibodies.
1. HBs antigen: this is a component of the envelope and is the earliest marker of HBV infection. It is present in serum prior to the onset of symptoms. If HBsAg is present in serum for more than 6 months the patient is defined as a "carrier".
2. HBe antigen: this is the next marker detectable. Presence of HBeAg generally indicates high infectivity.
3. HBc antigen: this antigen is only present in liver and therefore not detectable serologically.
4. Anti-HBs: this antibody develops as HBs antigen declines, therefore there can be a "window" between HBsAg declining to undetectable levels and anti-HBs rising to detectable levels. Development of anti-HBs implies clearance of the virus and development of immunity.
5. Anti-HBc: this is the earliest antibody detectable and is usually present with or soon after the onset of clinical symptoms of acute infection (IgM then IgG). Total anti-HBc is measured and anti-HBc IgM. The latter usually becomes negative within 6 months following acute infection.
6. Anti-HBe: this develops as HBe antigen declines.
Test performed by the Virology/Immunology laboratory.
For results, use ward computer or phone Lablink: 5995 or (09) 307-8995 or 0800 522 758.
GENERAL INFORMATION and DIAGNOSTIC USE:
Hepatitis C is transmitted predominantly by the parenteral route and was responsible for most of the post transfusion-related hepatitis until screening was introduced in 1992. The highest incidence of HCV is found in intravenous drug abusers, haemophiliacs, and past recipients of blood products. Transmission may also occur vertically (approximately 6% in the non-HIV infected pregnancy) and rarely, between sexual partners.
The majority of acute hepatitis C infections are asymptomatic. Some 20% of patients clear the virus spontaneously while 80% remain chronically infected and may progress to chronic liver disease, cirrhosis and in 20%, eventual heptocellular carcinoma.
Since antibodies may take several weeks to develop, PCR for HCV RNA may be required to confirm acute infection. Please state "suspected acute HCV infection" on the request form.
SEROLOGY:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube. (NOT heparin). 0.5 mL serum generally sufficient.
# Tests performed daily.
HEPATITIS C - RNA / HCV Viral Load:
Includes:
(a) Viral genotype. HCV genotype should be determined before treatment commences.
(b) HCV viral load. Used to establish pre-treatment viral levels and then subsequent response to treatment. The same technology is used for qualitative HCV testing.
SPECIMENS:
Blood: 7 mL blood EDTA tube. (NOT heparin). Require a dedicated EDTA tube specimen (no other tests requested).
Separate plasma within 5 hours of collection into a sterile tube.
Transport at 2 - 8?C if transport time from collection is < 72 hours.
Transport frozen if transport time from collection is > 72 hours.
Tissue: Fresh tissue, e.g. liver.
# Tests performed approximately twice weekly. Results available within a week.
Test performed by the Virology/Immunology laboratory.
For results, use ward computer or phone Lablink: 5995 or (09) 307-8995 or 0800 522 758.
Full clinical details are essential. This enables the laboratory to select appropriate tests and request additional specimens where necessary to establish the diagnosis. Additional consultation may be indicated.
NOTE: DO NOT USE HEPARIN TUBES for any Virology Specimens
HEPATITIS B VIRUS - DNA / Viral Load: Blood
Quantitative testing for hepatitis B DNA in plasma (HBV Viral Load):
SPECIMEN: 5 mL blood EDTA tube. (NOT heparin). Require a dedicated EDTA tube specimen (no other tests requested).
Separate plasma (minimum volume 2 mL), within 5 hours of collection, into a sterile tube.
Transport at 2 - 8 oC if transport time from collection is less than 72 hours. Transport frozen if more than 72 hours.
Hepatitis B virus mutation detection can be performed on this specimen.
Quantitative tests give useful information regarding potential infectivity and are also used to follow response to therapy.
Note: This is currently measured using the Roche COBAS Taqman version 1 assay. The result is reported in International Units (IU) where 1 International Unit = 5.82 viral copies (virions). This conversion figure refers to HBV DNA only (not HCV or HIV)
HEPATITIS B VIRUS - DNA: Tissue
SPECIMEN: Fresh liver biopsy
Also see Hepatitis B Infection
HEPATITIS C VIRUS - RNA / HCV Viral Load: Blood
Quantitative testing for HCV RNA in plasma (HCV Viral Load)
(Note: Qualitative testing for HCV RNA will be performed using the quantitative - Viral Load technology).
SPECIMEN: 5 mL blood EDTA tube. (NOT heparin). Require a dedicated EDTA tube specimen (no other tests requested).
Separate plasma (minimum volume 2 mL), within 5 hours of collection, into a sterile tube.
Transport at 2 - 8 oC if transport time from collection is less than 72 hours. Transport frozen if more than 72 hours.
Note: Quantitative testing for genotype 1 HCV is currently measured using the Roche COBAS Taqman version 1 assay.
Quantitative results are reported in International Units (IU) where 1 International Unit = 3.8 viral copies (virions). This conversion figure refers to HCV only (not HBV or HIV) .
HEPATITIS C VIRUS - RNA: Tissue
SPECIMEN: Fresh liver biopsy
Also see Hepatitis C Infection .
HEPATITIS D VIRUS - RNA:
SPECIMEN:
Blood: 5 mL blood EDTA tube. (NOT heparin). Require a dedicated EDTA tube specimen (no other tests requested).
Separate plasma (minimum volume 2 mL), within 5 hours of collection, into a sterile tube.
Transport at 2 - 8 oC if transport time from collection is less than 72 hours. Transport frozen if more than 72 hours.
Tissue: Fresh liver biopsy.
HEPATITIS E VIRUS - RNA:SPECIMEN:
Qualitative: 5 mL blood EDTA tube (NOT heparin)
Acute: Stool sample
# All tests performed as requested. Result available within 5 days.
The following tests should be ordered for the investigation of possible D virus infection:
SPECIMEN: 3.5 ml blood in a SST tube (preferred) or 10ml blood in a plain tube.
Order the following tests:
HbsAg
Anti HDV (if HBsAg is positive)
Following consultation with the Virology Department (contact via Lablink; 5995 or (09) 307-8995 or 0800 522 758, the following investigations may be warranted:
HDV-RNA (if anti HDV is positive)
Test performed by the Virology/Immunology laboratory.
For results, use ward computer or phone Lablink: 5995 or (09) 307-8995 or 0800 522 758.
The following tests should be ordered for the investigation of possible hepatitis E infection:
SPECIMEN: 3.5 mL blood in an SST tube (preferred) or 10 mL blood in a plain tube.
DIAGNOSTIC USE:
Hepatitis E is endemic in developing countries including parts of Africa, Asia, Central and South America. Infection in non-travelling New Zealanders is rare but has been detected.
Like Hepatitis A, it is transmitted via the faecal-oral route. The incubation period is approximately 2 - 10 weeks. Importantly it can cause fulminant and fatal infection in pregnant women, especially in the third trimester. Chronic carriage has not been described.
Hepatitis E RNA assay is performed at LabPlus
Serology for Hepatitis E is sent to Sydney.