Chronic Hepatitis Screen (unknown etiology)

Reporting Name


Determination of the etiological agent of chronic hepatitis.


Useful For

Determination of an infectious cause of chronic hepatitis


Profile Information

Acute Unknown Hepatitis Screen Available separately Always performed
HBsAg Neutralization NO NO
Anti-HBc Total Ab NO YES


Reflex Tests

Reporting Name Available separately Always performed
HBsAg Confirmation (neutralization) NO NO*

* Autoreflex of HBsAg-reactive to HBsAg Neutralization Confirmation


Testing Algorithm

Specimens submitted for Chronic Unknown Hepatitis Screen will be tested for hepatitis B surface antigen with autoreflex neutralization confirmation (HBsAg); hepatitis B surface antibody (Anti-HBs); hepatitis B core total antibodies; and  hepatitis C antibodies (Anti-HCV).


Hepatitis Algorithm


Indications for Testing

Chronic hepatitis of unknown etiology


Special Instructions and Forms

Hepatitis Algorithm

Hepatitis Interpretive


Method Name

Enzyme Immunoassay (EIA)


Reporting Name



Anti-HBc total






Specimen Required

Serology: Blood in SST. Allow blood to clot at room temperature for 30 minutes and centrifuge. Do not separate serum. Maintain at 2-8°C and transport on ice packs.


Specimen Minimum Volume



Transport Temperature

Specimen Room
Refrigerated Frozen
Serum NO YES* YES**

*The samples should be stored for not more than 3 days at 2-8°C.

**For longer delay, freeze at -70°C and transport on dry ice.


Reject Due To

Specimens other than Serum
Anticoagulants OK
Hemolysis OK
Lipemia OK
Icteric OK

Useful For

Determination of an infectious cause of chronic hepatitis


Clinical Information

Chronic viral hepatitis describes protracted hepatocellular necrosis and inflammation, often with fibrosis, that lasts longer than 6 months and is caused by hepatitis B virus (HBV), hepatitis C virus (HCV), or HBV-associated hepatitis D virus (HDV). Nonviral causes of chronic hepatitis that may be confused clinically with chronic viral hepatitis include autoimmune hepatitis, metabolic-genetic disorders (Wilson’s disease, hereditary hemochromatosis, α1 antitrypsin deficiency), alcoholic liver disease, and granulomatous disorders. The chronic viral hepatitides are readily distinguishable from these other causes of chronic hepatitis by the use of serological testing.


Chronic HBV infection is found in 0.5 % of adults in North America. After acute HBV infection, the risk of developing chronic infection varies with age; infants infected at birth have a 90% chance of becoming a chronic carrier. A chronic carrier is one who retains HBsAg positivity six months after the initial infection. These individuals are always infectious. Hepatocellular carcinoma and hepatic cirrhosis is likely to result in the premature death of 15-25% of those who have chronic HBV.


Hepatitis C virus (HCV), previously known as NANB hepatitis, which is spread predominantly by parenteral routes. An estimated 170 million people are infected worldwide, and HCV infection is now the leading cause for liver transplantation in the United States because of its propensity to cause chronic liver disease, cirrhosis, and hepatocellular carcinoma. Most infected people are asymptomatic with onset of disease being insidious. Symptoms range from anorexia, fatigue, fever, myalgia, nausea and vomiting progressing to jaundice. More than 50% of those infected will develop chronic HCV infection. Of those
chronically infected about half will develop cirrhosis or cancer of the liver.


Reference Values




Special instructions link, Hepatitis Interpretive


Clinical Reference

Curry, M. P., and Chopra, S. 2010. Acute Viral Hepatitis, p. 1577-1592. In Mandell, D., Bennett, J. E., and Dolin, R. Principles and practice of infectious diseases, 7th ed., vol. 2. Churchill Livingstone, Elsevier, Philadelphia, PA.



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