Tests
1st tests to order
serum aminotransferases
Test
Test should be ordered as soon as clinical symptoms begin.[22][23] Aminotransferase levels may reach more than 10,000 units/L, although there is little correlation between level and disease severity. The serum alanine aminotransferase is commonly higher than the serum aspartate aminotransferase. The serum aminotransferases elevation usually precedes bilirubin elevation. Alkaline phosphatase level is usually elevated minimally.
Result
elevated
serum bilirubin
Test
The bilirubin level is usually elevated to about 5-10 mg/dL.[41]
Result
elevated
BUN
Test
Acute kidney injury has been reported in patients with HAV.[42] This, with other markers, may also be indicative of acute liver failure.
Result
elevated in acute liver injury/failure
serum creatinine
Test
Acute kidney injury has been reported in patients with HAV.[42] This, with other markers, may also be indicative of acute liver failure.
Result
elevated above 2 mg/dL in acute liver injury/failure
prothrombin time
Test
Mainly ordered as baseline test.
Mild elevations of about 11-26 seconds are common in HAV infection.
Result
may be mildly prolonged; more marked prolongation with acute liver failure
immunoglobulin M (IgM) antihepatitis A virus (HAV)
Test
IgM anti-HAV test should be ordered when patient is symptomatic or HAV is suspected.[1] High sensitivity and specificity when used on specimens from persons with typical symptoms.[22] Usually can be detected 5-10 days before symptom onset; levels become undetectable by 6 months after symptom onset.[1][24][25] Can be ordered along with IgG anti-HAV.
Result
positive
Tests to consider
immunoglobulin G (IgG) antihepatitis A virus (HAV)
Test
IgG anti-HAV and total anti-HAV (IgM and IgG anti-HAV combined) tests are not helpful in diagnosing acute illness.[1] Levels begin to rise soon after IgM levels and stay elevated throughout the person's lifetime; therefore, positive result can mean prior infection or recent disease and should be interpreted along with results of IgM anti-HAV and clinical features.[1][24] Can be ordered along with IgM anti-HAV.
Result
positive
hepatitis A virus RNA detection
Test
High sensitivity and specificity, but very rarely used in routine settings.
May be used to detect very early cases or if serology is inconclusive.[8]
Result
nucleic acid amplification techniques using body fluids serum, stool, and liver tissue
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