1st order laboratory parameters – obligatory laboratory tests.
- Serology* – Detection of hepatitis E-specific antibodies [Note: In transplanted patients, months to years may pass before measurable antibodies are produced in the setting of chronic hepatitis E! → HEV RNA by PCR, see below]
- HEV antigen detection (hepatitis E antigen) in blood or stool [indicates fresh hepatitis E infection].
- Anti-HEV IgM * * – indicative of fresh hepatitis A infection [usually positive only in the 2nd-4th week of illness; falls off quickly after healing: detectable for 3-12 months].
- Anti-HEV IgG * * – indicates an expired infection or a performed vaccination [contamination in Germany in blood donors about 1.0%; persistence over at least 14 years; indicator of existing immunity to reinfection].
Note: A negative hepatitis E virus (HEV) serology does not completely exclude HEV infection.
- If necessary, HEV RNA by PCR in blood (EDTA blood) or stool [evidence of a fresh (seronegative) or infectious HEV disease] Note: In immunocompromised patients should always be tested directly by HEV PCR.
- 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 [AST ↑↑, ALT ↑↑, AP ↑, gamma-GT ↑; bilirubin ↑↑] [ALT > AST]Note: In chronic hepatitis E virus infection, only mildly elevated transaminases are detectable; leading elevated cholestasis parameters (alkaline phosphatase, gamma-GT, bilirubin) are often.
* Namely in the sense of the Infection Protection Act, the suspected disease, the disease as well as death from acute viral hepatitis must be reported.* * If anti-HEV is positive, a determination of HEV RNA should be made.
2nd order laboratory parameters – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification
- Antibodies against hepatitis virus A, B, C, D.
- 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.
