Test Catalog

Test ID: CRHEP    
Chronic Hepatitis (Unknown Type), Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosis and evaluation of patients with symptoms of hepatitis with a duration more than 6 months


Distinguishing between chronic hepatitis B and chronic hepatitis C

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If hepatitis C virus (HCV) antibody is reactive, then HCV RNA detection and quantification by real-time reverse transcription-PCR will be performed at an additional charge.


If hepatitis B surface antigen is reactive, then confirmation will be performed at an additional charge.


The following algorithms are available in Special Instructions:

-Chronic Hepatitis C Treatment and Monitoring Algorithm: Direct Antiviral Antigen (DAA) Combination

-HBV Infection-Diagnostic Approach and Management Algorithm

-Hepatitis C: Testing Algorithm for Screening and Diagnosis

-Viral Hepatitis Serologic Profiles

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Hepatitis B:

Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. The infection is spread primarily through percutaneous contact with infected blood products (eg, blood transfusion, sharing of needles by drug addicts). The virus is also found in virtually every type of human body fluid and is known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions; it is not commonly transmitted transplacentally.


After a course of acute illness, HBV persists in approximately 10% of patients. Some of these carriers are asymptomatic; others develop chronic liver disease including cirrhosis and hepatocellular carcinoma.


Hepatitis C:

Hepatitis C virus (HCV) is an RNA virus that is a significant cause of morbidity and mortality worldwide. HCV is transmitted through contaminated blood or blood products or through other close, personal contacts. It is recognized as the cause of most cases of post-transfusion hepatitis. HCV shows a high rate of progression (>50%) to chronic disease. In the United States, HCV infection is quite common, with an estimated 3.5 to 4 million chronic HCV carriers. Cirrhosis and hepatocellular carcinoma are sequelae of chronic HCV.


The following algorithms are available in Special Instructions:

-Chronic Hepatitis C Treatment and Monitoring Algorithm: Direct Antiviral Antigen (DAA) Combination

-HBV Infection-Diagnostic Approach and Management Algorithm

-Hepatitis C: Testing Algorithm for Screening and Diagnosis

-Viral Hepatitis Serologic Profiles

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.





Hepatitis B Surface Antibody

Unvaccinated: negative

Vaccinated: positive


Hepatitis B Surface Antibody, Quantitative

Unvaccinated: <5.0 mIU/mL

Vaccinated: > or =12.0 mIU/mL








Interpretation depends on clinical setting.

Interpretation Provides information to assist in interpretation of the test results

Interpretation depends on clinical setting. See Viral Hepatitis Serologic Profiles in Special Instructions.


Chronic Hepatitis B:

Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B viral (HBV) infection. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either a chronic carrier state or chronic HBV infection.


Hepatitis B core antibodies (anti-HBc Ab) appear shortly after the onset of symptoms of HBV infection and soon after the appearance of HBsAg. The IgM subclass usually falls to undetectable levels within 6 months, and the IgG subclass may remain for many years.


Hepatitis B surface antibody (anti-HBs) usually appears with the resolution of hepatitis B virus infection after the disappearance of HBsAg.


If HBsAg and anti-HBc (total antibody) are positive and patient's condition warrants, consider testing for hepatitis Be antigen (HBeAg), anti-HBe, hepatitis B virus DNA (HBV-DNA) or anti-hepatitis D virus (anti-HDV).


Chronic Hepatitis C:

Anti-HCV is almost always detectable by the late convalescent and chronic stage of infection.


The serologic tests currently available do not differentiate between acute and chronic hepatitis C infections.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Positive hepatitis B surface antigen (HBsAg) test results should be reported by the attending physician to the State Department of Health as required by law in some states.


Consider administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine to HBsAg antibody negative individuals exposed to the HBsAg-positive patient's blood or body fluids.


Neonates (<1 month old) with positive hepatitis B core (anti-HBc) total antibody results from this assay method should be tested for anti-HBc IgM antibody to rule-out possible maternal anti-HBc total antibody causing false-positive results. Repeat testing for anti-HBc total antibody within 1 month is also recommended in these anti-HBc total antibody-positive neonates.


Assay performance characteristics have not been established for:

-Individuals under 10 years of age (HCVDX)

-Grossly icteric (total bilirubin level of >20 mg/dL)

-Grossly lipemic (triolein level of >3,000 mg/dL)

-Grossly hemolyzed (hemoglobin level of >500 mg/dL)

-Cadaveric specimens

-Those that contain particulate matter

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Wietzke P, Schott P, Braun F, et al: Clearance of HCV RNA in a chronic hepatitis C virus-infected patient during acute hepatitis B virus superinfection. Liver 1999;19:348-353

2. Villari D, Pernice M, Spinella S, et al: Chronic hepatitis in patients with active hepatitis B virus and hepatitis C virus combined infections: A histological study. Am J Gastroenter 1995;90:955-958

3. Bonino F, Piratvisuth T, Brunetto MR, et al: Diagnostic markers of chronic hepatitis B infection and disease. Antiviral Therapy 2010;15(3):35-44

4. American Association for the Study of Liver Diseases and Infectious Diseases Society of America: HCV guidance: Recommendations for testing, managing, and treating hepatitis C. Accessed July 14, 2017 Available at:  www.hcvguidelines.org/full-report-view

5. Badur S, Akgun A: Diagnosis of hepatitis B infections and monitoring of treatment. J Clin Virol 2001;21:229-237

Special Instructions Library of PDFs including pertinent information and forms related to the test