Hepatitis E Antibody


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Hepatitis E Antibody

Synonym/acronym: HEV.

Common use

To test blood for the presence of antibodies that would indicate a past or current hepatitis E 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 h of collection.

Normal findings

(Method: Enzyme immunoassay) Negative.

Description

The hepatitis E virus is classified as a single-stranded RNA hepevirus with five separate genotypes. HEV is a major cause of enteric non-A hepatitis worldwide; about 20% of the U.S. population demonstrates presence of immunoglobulin G (IgG) antibody. Its primary mode of transmission is the fecal-oral route under conditions of poor personal hygiene or inadequate sanitation. The incubation period is about 28 days. IgM and IgG are detectable within one month mo after infection. Onset is usually abrupt, with the acute disease lasting several weeks. Therapy is supportive, and patients usually recover, although the disease is quite debilitating during the acute phase. Hepatitis E infection can occasionally develop into a severe liver disease and may cause chronic infection in organ transplant or other immunocompromised patients. Assays for total (IgG and immunoglobulin M [IgM]) hepatitis E antibody and IgM-specific hepatitis E antibody help differentiate 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. IgM remains detectable for about 2 mo; IgG levels persist for months to years after recovery.

This procedure is contraindicated for

    N/A

Indications

  • Screen individuals with suspected HEV infection

Potential diagnosis

Positive findings in:

  • Individuals with current HEV infection
  • Individuals with past HEV infection

Critical findings

    N/A

Interfering factors

    N/A

Nursing Implications and Procedure

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).
  • 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. 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. Discuss chronic infection in organ transplant or other immunocompromised patients.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Provide contact information, if desired, for the Centers for Disease Control and Prevention (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 Monographs

  • Related tests include ALT, ALP, AST, bilirubin, GGT, and HAV, HBV, HBC, and HBD antigens and antibodies.
  • Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.