Hepatitis A; Transmission, Symptoms, Diagnosis & Treatment

Diagnosis of Hepatitis A

The most reliable way to diagnose hepatitis A is through nucleic acid testing. This is known as the gold standard, but it is sometimes too difficult to perform in all patients. Thus, instead of using the gold standard, doctors prefer to take a history of the disease and examine the patient. This is more cost-effective, and any diagnosis can be confirmed with serology tests.

In the diagnostic process, it is important to rule out drugs that cause liver injury and other causes of the disease’s misdiagnosis. That’s why some doctors order serum acetaminophen levels and other additional tests. A liver biopsy is only performed when the diagnosis is uncertain and in chronic relapsing hepatitis A infections.

But what other exams could a doctor request from you to complete the diagnosis? Here’s a helpful list:

• Complete blood count: This blood test is useful to detect the proportion of lymphocytes in your white blood cells. Lymphocytosis or an increase in lymphocytes is clear indicative of a viral disease. In some patients, we can also have other alterations such as pancytopenia (a reduction in all cell lines in the complete blood count).
• Coagulation study: This study should include the prothrombin time. This coagulation study depends on a substance normally synthesized in the liver. Thus, when this organ is compromised, coagulation starts to slow down. Prothrombin time can be a helpful reference to monitor liver function.
• Liver enzymes: They are mandatory to research almost any condition that has to do with the liver. The liver enzymes include the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT). They are both useful to detect hepatitis A, and their levels sometimes go higher than 10,000 mIU/mL. ALT levels are usually greater than AST, and they take a very long time to recover their normal ranges.
• Bilirubin measures: It is also essential to measure bilirubin levels in the blood. Similar to liver enzymes, bilirubin levels are usually very high and stay high for months. They should not take more than 3 months to go back to their normal ranges. If they do, doctors may require to rule out an infection of the bile ducts by the hepatitis A virus.
• Anti hepatitis A serologic tests: These are fundamental for the diagnosis of hepatitis A. Along with clinical data and the physical exam, serologic tests are usually enough. Doctors can ask for IgM, IgG, or both. The difference is that anti-hepatitis A virus IgM rises in the acute phase of the infection. In other words, when you’re currently infected and recently started with your symptoms. In contrast, IgG levels rise when your body has been exposed to the virus in the past. For example, in patients with previous immunization and those with past infection.