Hepatitis D: Lab Test

1st order laboratory parameters – obligatory laboratory tests.

  • Serology – detection of hepatitis D-specific antigens (persists only briefly; 1-2nd week of acute infection; in superinfection)* .
    • Anti-HDV antibody
      • Anti-HDV IgM ELISA (serum): often the only marker during the late acute stage (hepatitis D antigen already negative); persistence is often observed during the chronic course.
      • Anti-HDV IgG ELISA (serum): often replaces the IgM antibody and persists only briefly during healing.
  • HDV RNA (when anti-HDV antibody is positive; RT-PCR): hepatitis D-PCR (EDTA blood) has the highest sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e., a positive test result occurs) in fresh (seronegative) infections.
  • Serology – detection of hepatitis B-specific antigens* .
    • Hepatitis B surface antigen (HBsAg).
    • Hepatitis B core antigen (HBcAg)
    • Hepatitis B e antigen (HBeAg)
    • IgM and IgG antibodies (anti-HBs, anti-HBc, anti-HBe) [detection of simultaneous infection (fresh hepatitis B infection): anti-HBc IgM; in superinfection, this marker is often no longer detectable].
  • Alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), and gamma-glutamyl transferase (γ-GT, gamma-GT; GGT) [ALT > AST].

* Direct or indirect detection must be reported by name if the evidence indicates acute infection (Law on Prevention and Control of Infectious Diseases in Humans).

Testing for HDV should be performed in all individuals who have newly diagnosed HBV infection; this should also be followed up in those with known HBV and untested HDV.

Second-order laboratory parameters-depending on the results of the history, physical examination, etc.-for differential diagnostic clarification

  • Antibodies against hepatitis virus A, C, E.
  • 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.