Hepatitis tests include measurements of serologic markers that appear during the course of the disease caused by the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus. Laboratory methods used in the detection of specific antigens or antibodies include radioimmunoassay (RIA) and enzyme immunoassay (EIA).

Hepatitis A is a self-limiting disease that does not usually cause liver damage or a chronic infectious state. It occurs as the result of oral ingestion of the virus and is characterized by malaise, anorexia, fever, and nausea. The virus is present in the feces, but diagnosis is based on serologic markers (anti-HAV, IgM, IgG) identified in the laboratory. The diagnosis is made for hepatitis A if anti-HAV antibodies can be demonstrated in the early acute stage of the disease or if there is a high level of IgM anti-HAV compared to the level of the IgG antibody to HAV. IgM antibodies appear in the early stages, and IgG antibodies indicate past infection and immunity to reinfection.

Hepatitis B, also known as the Australian antigen, is a more serious, prolonged disease that can result in liver damage and chronic active hepatitis. HBV can be found in the blood, feces, saliva, semen, sweat, urine, or any body fluid of infected individuals and can be transmitted by exposure to blood products or parenteral contact with articles contaminated with material containing the virus. Diagnosis is made by identification of the hepatitis B surface antigen (HBsAg) circulating in the blood before and during the acute early stage before enzyme elevations or in chronic carriers after an acute illness. It is the first indicator of acute hepatitis infection. The recovery from and immunity to HBV as late as 6 to 10 months after an active infection are identified by the detection of anti-HBs. The presence of hepatitis B antibody (anti-HBe, HBeAb) indicates the resolution of acute infection or, along with positive HBsAg, indicates an asymptomatic, healthy carrier. The presence of hepatitis B e antigen (HBeAg) is an early indicator of hepatitis B infection. If HBeAg persists for more than 3 months, it is indicative of chronic infection. Delta hepatitis coinfects with HBV, and diagnosis is made by detection of the antibodies (anti-D) in the blood.

Hepatitis C is a parenterally acquired disease usually caused by blood transfusion but also by IV drug abuse. The disease can lead to chronic hepatitis and cirrhosis of the liver. The test is performed to detect the antibodies to HCV in the blood of those at risk for the infection and transmission of the virus as a blood donor. Antibody formation can take as long as a year after exposure to the virus.

Hepatitis D is caused by a "defective" virus that can produce infection only when HBV is present. HDV antigens do not circulate and are found only in hepatocytes. Hepatitis D occurs with HBV and can result in more serious disease in individuals with chronic HBV infection. Hepatitis D is also known as delta agent hepatitis.

Hepatitis E is similar in presentation and disease course to hepatitis A. It occurs primarily in Asia, Africa, and South America.³²

• The administration of radionuclides within 1 week of testing using the RIA technique can cause inaccurate results.
• Rheumatoid factor and competing IgG-specific antibody can cause inaccurate positive and negative results.

• Detection of the presence of antigen or antibody to a specific type of hepatitis depending on symptoms and stage of the disease in the diagnosis of the condition
• Determination of possible hepatitis carrier status
• Determination of past exposure or immunity status in those with a history of hepatitis
• Screening of pretransfusion donors for a history or presence of hepatitis, especially if asymptomatic and information source questionable
• Determination of progression to chronic hepatitis or persistent signs and symptoms of liver dysfunction

Nursing Care Before the Procedure

Client preparation is the same as for any study involving the collection of a peripheral blood sample (see Appendix I).

• Obtain a thorough history regarding possible ingestion of contaminated water or foods, environmental sanitation factors conducive to occurrence, recent blood transfusion, parenteral exposure to materials contaminated by blood or body fluids, personal contact through sexual activity, or presence of pregnancy (the infection could be transmitted to the infant).³³

A venipuncture is performed and the sample collected in a red-topped tube. For screening tests, the directions accompanying the test kit are followed. For traditional testing, the sample should be sent to the laboratory promptly, with the test performed within 7 days or frozen for future analysis.

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any study involving the collection of a peripheral blood sample.

• Abnormal values: Note and report presence of antigen or antibody to a specific type of hepatitis. Provide rest and energy-saving assistance as needed, skin care for jaundice and pruritus, and adequate nutritional and fluid intake.
• Disease transmission: Note and report type of hepatitis. If hepatitis A, place client on enteric precautions. If hepatitis B, C, or D, observe standard precautions for blood-borne pathogens (see Appendix III for hand protection, personal protection, and needles and sharps), and instruct in precautions against transmission via sharing of needles by IV drug abusers and sexual contact.
• Disease prevention: Hepatitis A and B vaccines for active immunity. Instruct client to avoid donating blood for 6 months if a transfusion has been received and to never donate blood if diagnosis of hepatitis B has been made.