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Related to delta hepatitis: hepatitis E
vi·ral hep·a·ti·tis type D
acute or chronic hepatitis caused by a satellite virus, the hepatitis delta virus, a defective RNA virus requiring HBV for replication because it uses HBsAg as its own coat. The acute type occurs in two forms: 1) coinfection, the simultaneous occurrence of hepatitis B virus and hepatitis delta virus infections, which usually is self-limiting; 2) superinfection, the appearance of hepatitis delta virus infection in a hepatitis B virus carrier, which often leads to chronic hepatitis The chronic type appears to be more severe than other types of viral hepatitis.
See hepatitis D.
vi·ral hep·a·ti·tis type D(vī'răl hep'ă-tī'tis tīp)
Acute or chronic hepatitis caused by the hepatitis delta virus, a defective RNA virus requiring hepatitis B virus for replication. The acute type occurs in two forms: 1) coinfection, the simultaneous occurrence of hepatitis B virus and hepatitis delta virus infections; 2) superinfection, the appearance of hepatitis delta virus infection in a hepatitis B virus carrier.
Synonym(s): delta hepatitis.
Synonym(s): delta hepatitis.
delta hepatitisAn acute, often severe, form of HEPATITIS caused by an RNA virus which is dependent on the hepatitis B virus for its replication. It is acquired along with the hepatitis B virus or it can infect hepatitis B carriers, in both cases by close personal contact or needle sharing.
Hepatitis D Antibody
Synonym/acronym: Delta hepatitis.
To test blood for the presence of antibodies that would indicate a past or current hepatitis D infections.
SpecimenSerum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.
(Method: Enzyme immunoassay, EIA) Negative.
Symptoms of hepatitis D virus (HDV) infection are similar but often more severe than those of hepatitis B virus (HBV) infection. As with HBV, the primary modes of HDV transmission are parenteral, perinatal, and sexual contact. The virus contains a single-stranded RNA core. In order to replicate, it requires the presence of the hepatitis B outer coat. Therefore, HDV infection can only occur with hepatitis B coinfection or superinfection. Onset is abrupt, after an incubation period of 3 to 13 wk. Because of its dependence on HBV, prevention can be accomplished by using the same pre-exposure and postexposure protective measures used for HBV (see monograph titled ‘Hepatitis B Antigen and Antibody’).
This procedure is contraindicated for
Establish the presence of coinfection or superinfection in patients with HBV (clinical course of superinfection is more severe)
Positive findings in:
- Individuals currently infected with HDV
- Individuals with a past HDV infection
Drugs that may decrease hepatitis D antibody levels include interferon.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in evaluating for hepatitis infection.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s hepatobiliary and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a history of IV drug use, high-risk sexual activity, and occupational exposure.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
- Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
- Nutritional considerations: Dietary recommendations may be indicated and will vary depending on the type and severity of the condition. Explain the importance of providing an adequate daily fluid intake of at least 4 L. Monitor the patient’s weight, intake, and output each day, and assess for development of ascites. Elimination of alcohol ingestion and a diet optimized for convalescence are commonly included in the treatment plan. As a general rule, small, frequent meals that are high in carbohydrates and low in fat will provide the required energy while not burdening the inflamed liver.
- Cultural and social considerations: Recognize anxiety related to test results, and be supportive of impaired activity related to lack of neuromuscular control, perceived loss of independence, and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Counsel the patient, as appropriate, regarding the risk of transmission and proper prophylaxis. Stress the importance of hand hygiene to prevent transmission of the virus. Hepatitis B immune globulin (HBIG) vaccination should be given immediately after situations in which there is a potential for HBV exposure (e.g., accidental needle stick, perinatal period, sexual contact) for temporary, passive protection.
- Counsel the patient and significant contacts, as appropriate, that HBIG immunization is available and has in fact become a requirement in many places as part of childhood immunization and employee health programs. Parents may choose to sign a waiver preventing their newborns from receiving the vaccine; they may choose not to vaccinate on the basis of philosophical, religious, or medical reasons. Vaccination regulations vary by state.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Provide information regarding vaccine-preventable diseases where indicated (e.g., hepatitis B). Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/vpd-vac) and (www.cdc.gov/DiseasesConditions). Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include ALT, ALP, antibodies antimitochondrial antibodies, AST, bilirubin, biopsy liver, culture anal, Chlamydia group antibody, cholangiography percutaneous transhepatic, GGT, hepatitis A, B, C, and E antibodies/antigens, HIV serology, liver and spleen scan, syphilis serology, US liver.
- Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.