1st order laboratory parameters – obligatory laboratory tests.
- Serology
- Detection of hepatitis C-typical antigens (ELISA test: hepatitis C antibodies are formed after 4-6 weeks at the earliest; usually after 2-6 months)* .
- Anti-HCV – but is not suitable for ruling out acute hepatitis C, as it does not become positive until several weeks after infection.
- HCV immunoblot – specific confirmatory test (to clarify a positive ELISA test).
- HCV-PCR* * (HCV RNA: detection of fresh (seronegative) or chronic or infectious HCV disease/parameter to determine the activity and infectivity (contagiousness) of hepatitis C).
- Liver parameters-alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), and gamma-glutamyl transferase (γ-GT, gamma-GT; GGT); alkaline phosphatase, bilirubin [ALT > AST].
* In particular, in terms of the Infection Protection Act, the suspected disease, the disease as well as death from acute viral hepatitis must be reported.* * As a surrogate marker (measured value, the influence of which is to indicate the effect of a therapy, on the occurrence of a disease) of a cure is the sustained virologic response (SVR). This is defined as the absence of detection of HCV RNA in the blood six months after the end of therapy.
Serologic parameters in hepatitis C infection
Overview of possible constellations of laboratory diagnostic results and their evaluation:
| HCV RNA / antigen | HCV antibody (IgG+IgM) | Infection status |
| negative | negative | susceptible (receptive) |
| positive | negative | acute infection |
| positive | questionable | acute infection |
| positive | positive | acute or chronic infection |
| negative (with sensitivity 10- 25 IU/ml ) | positive | Cured (spontaneously or at least six months after end of therapy) |
2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification
- HCV genotype determination
- Antibodies against hepatitis virus A, B, D, E
- HIV test – hepatitis C is considered an indicator disease for HIV.
- Bacteria
- Borrelia
- Brucella
- Chlamydia
- Gonococcus
- Leptospires
- Mycobaterium tuberculosis
- Rickettsiae (e.g., Coxiella burnetii)
- Salmonella
- Shigella
- Treponema pallidum (lues)
- Helminths
- Ascaris
- Bilharzia (schistosomiasis)
- Liver fluke
- Trichinae
- Protozoa
- Amoebae
- Leishmania (leishmaniasis)
- Plasmodia (malaria)
- Toxoplasmosis
- Viruses
- Adeno viruses
- Coxsackie viruses
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
- Yellow fever virus
- Herpes simplex virus (HSV)
- Mumps virus
- Rubella virus
- Varicella zoster virus (VZV)
- Autoimmune diagnostics: ANA, AMA, ASMA (anti-SMA = AAK against smooth muscle), anti-LKM, anti-LC-1, anti-SLA, anti-LSP, anti-LMA.
- Gamma-glutamyl transferase (γ-GT, gamma-GT; GGT) – for suspected alcohol abuse.
- Aspartate aminotransferase (AST, GOT), alanine aminotransferase (ALT, GPT) [↑ only in case of liver parenchyma damage].
- Carbodeficient transferrin (CDT) [↑ in chronic alcoholism]* .
- Transferrin saturation [suspected in men > 45%, pre-menopausal women > 35%] – in suspected hemochromatosis (iron storage disease).
- Coeruloplasmin, total copper, free copper, copper in urine – if Wilson’s disease is suspected.
