Hepatitis A Antibody

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Hepatitis A Antibody

Synonym/acronym: HAV serology.

Common use

To test blood for the presence of antibodies that would indicate a past or current hepatitis A infection.

Specimen

Serum (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.

Normal findings

(Method: Enzyme immunoassay) Negative.

Description

The hepatitis A virus (HAV) is classified as a picornavirus. Its primary mode of transmission is by the fecal-oral route under conditions of poor personal hygiene or inadequate sanitation. The incubation period is about 28 days, with a range of 15 to 50 days. Onset is usually abrupt, with the acute disease lasting about 1 wk. Therapy is supportive, and there is no development of chronic or carrier states. Assays for total (immunoglobulin G and immunoglobulin M [IgM]) hepatitis A antibody and IgM-specific hepatitis A antibody assist in differentiating recent infection from prior exposure. If results from the IgM-specific or from both assays are positive, recent infection is suspected. If the IgM-specific test results are negative and the total antibody test results are positive, past infection is indicated. The clinically significant assay—IgM-specific antibody—is often the only test requested. Jaundice occurs in 70% to 80% of adult cases of HAV infection and in 70% of pediatric cases.

This procedure is contraindicated for

    N/A

Indications

  • Screen individuals at high risk of exposure, such as those in long-term residential facilities or correctional facilities
  • Screen individuals with suspected HAV infection

Potential diagnosis

Positive findings in:

  • Individuals with current HAV infection
  • Individuals with past HAV infection

Critical findings

    N/A

Interfering factors

    N/A

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Fatigue (Related to decreased energy secondary to liver dysfunction associated with disease process and resulting inadequate absorption, metabolism and storage of nutrients)Decreased concentration; increased physical complaints; inability to restore energy with sleep; reports being tired; inability to maintain normal routineAssess for physical cause of fatigue; pace activities to preserve energy stores; rate fatigue on a numeric scale to trend degree of fatigue over time; identify what aggravates and decreases fatigue; assess for related emotional factors such as depression; evaluate current medications in relation to fatigue; assess for physiologic factors such as anemia
Knowledge (Related to new condition or diagnosis; lack of familiarity or understanding with disease and treatment)Lack of interest or questions; multiple questions; anxiety in relation to disease process and managementTeach the patient that the disease is transmitted by fecal-oral route, crowded living conditions, poor personal hygiene, contaminated water, contaminated food, contaminated milk, and raw shellfish; assess patient’s and family’s knowledge regarding disease, transmission, and treatment; assess for cultural, literacy, or vision and hearing concerns that would interfere with learning; explain that adequate nutrition and rest can prevent disease complications; demonstrate proper hand-washing technique with re-demonstration; emphasize vigilant hand washing; explain that crowded living conditions and poor sanitation should be avoided; encourage family members to receive hepatitis vaccine; make patients aware that sexual partners should receive the hepatitis vaccine
Infection (Related to crowded living conditions with poor sanitation; poor personal hygiene; fecal-oral exposure; exposure to contaminated water, milk, food; raw shellfish)Fever; fatigue; loss of appetite; jaundice; nausea and vomiting; dark-colored urine; abdominal pain; stool that is clay colored; joint pain; it is possible to be infected and have no symptomsExplain that the best treatment is adequate rest, good nutrition, and adequate fluid intake; recommend that family and significant others receive the hepatitis vaccination; explain that alcohol should be avoided to decrease risk of liver damage; explain that over-the-counter medication should be checked with the physician before taking to ensure there is no risk to the liver; explain that jaundice can last several months

Pretest

  • 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 list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • 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.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • 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.

Post-Test

  • 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. Elimination of alcohol ingestion and a diet optimized for convalescence are commonly included in the treatment plan. 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.
  • Social and Cultural Considerations: Recognize anxiety related to test results, and offer support. 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. Counsel the patient, as appropriate, regarding risk of transmission and proper prophylaxis. Stress the importance of hand hygiene to prevent transmission of the virus. Immune globulin can be given before exposure (in the case of individuals who may be traveling to a location where the disease is endemic) or after exposure, during the incubation period. Prophylaxis is most effective when administered 2 wk after exposure.
  • 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.
  • Patient Education

    • 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 A).
    • 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.
  • Expected Patient Outcomes

    • Knowledge
    • States the importance of washing hands after using the bathroom and prior to food preparation
    • States understanding that this disease is spread by contact with infected fecal matter
    • Skills
    • Demonstrates proficient hand washing
    • Grasps the importance of using protective personal equipment, such as gloves if necessary, to prevent disease transmission
    • Attitude
    • Complies with the request to avoid drinking untreated water
    • Complies with the request to avoid washing food in untreated water

Related Monographs

  • Related tests include ALT, ALP, AST, bilirubin, GGT, and HBV, HBC, HBD, and HBE antigens and antibodies.
  • Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.
References in periodicals archive ?
Simultaneous measurement of total antibody and IgM can be performed and may prove to be beneficial in helping physicians correctly interpret HAV serology.