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Diagnosis
One of the most important tools to detect hepatitis B is quantifying liver enzymes in the blood. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are usually the most common. However, we also have gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and other liver function tests that include albumin and bilirubin. Coagulation studies and other hematologic parameters also work to suspect liver conditions because the liver synthesizes important coagulation factors.
However, these tests and any suspicious patients should be compared with a serologic test for Hepatitis B. There’s a surface antigen in hepatitis B, which is commonly presented by antigen-presenting cells, and it is known as HBsAg. The hepatitis B core antibody (anti-HBc) should also be measured, as well as immunoglobulin M levels. The combination of serologic test results not only gives out hepatitis B diagnosis but also points out the disease phase. For example, IgM levels and anti-HBc are only positive in acute cases or recently infected patients. The HBsAg antigen is also positive in acute cases, but unlike IgM and Anti-HBc, it stays positive throughout the disease. It is also positive in patients who received the vaccine for hepatitis B virus. But if we have positive Anti-HBc and positive HBsAg with a negative IgM, this indicates a chronic disease.
Test results should always be companied by a complete medical examination. It is essential to know about any alcoholic or metabolic risk factors, the patient’s vaccination status, and family history of liver cancer, and evaluate any possible symptoms of cirrhosis.
Doctors would usually run a complete blood count with a platelet count, AST levels, ALT, bilirubin, albumin, and ALP along with Hepatitis B e antigen, Anti Hepatitis A-virus tests, and sometimes DNA levels of HBV in cases of occult HBV. They also recommend an abdominal ultrasound and sometimes a coinfection test with hepatitis C, hepatitis D, and HIV.
