Introduction
Hepatitis B will be reviewed from a physician‘s point of view.
Disclaimers
Any concerns with hepatitis B or any other form of viral hepatitis or any other form of hepatitis for that matter should be addressed by a physician directly.
Discussion
Nicely, here is one odd pneumonic to hang your hat on… And that is an odd frequency of the concept of “Both” when it comes to considering the many aspects of this infectious disease (B for both?).
How many types of viral hepatitis are there?`
When considering each form of viral hepatitis, there are many issues of infectivity and chronicity. And, at each quality of the viral hepatitis, there’s usually a choice of one or the other possibilities. Oddly, when each one of these important issues is considered for hepatitis B, it turns out, hepatitis B seems to display BOTH (“B” for both) of the possibilities in each circumstance. You’ll see what I mean…
Is Hepatitis B Sexually Transmitted?
Pneumonic: Both of everything
With the viral hepatitis diseases, they usually spread by either sexually transmitted disease (STD) and IV, or they spread by perinatal contact. When it comes to hepatitis B, it spreads by both STD and IV as well as perinatal contact.
Different viral hepatitidies A through E (and a bunch of others that I will probably not go through in this blog ever) may either demonstrate fulminant hepatic failure or a carrier state. When it comes to hepatitis B, it does both, fulminant hepatic failure and carrier.
Also, when it comes to perinatal transmission, each form of viral hepatitis that is perinatally transmitted may or may not move onto a permanent carrier state afterward. Hepatitis B gives you Both the perinatal transmission, plus is more likely to become a carrier when it is transmitted perinatally.
The hepatitis B patient that received their hepatitis B perinatally is also more likely to have a greater carcinoma risk as they get older. Another bad Both, unfortunately.
How is Hepatitis B Diagnosed?
Anyway, onto diagnosing hepatitis B. The laboratory interpretation is complicated.
The first thing you get is a surface antigen for this virus. Then there is a window where not a whole lot shows up in the blood. The next thing you get, so the second thing, is the antibody, the IgM (M if you recall from an earlier pneumonic is the iMMediate response antibody to an infectious agent – not M for memory antibody!) to the core of the Hepatitis B virus. So, IgM to core is The only thing that’s positive in this window. So, this is a very important part of the screening, because a lot of clinicians are looking for i’ll kinds of antibodies and antigens at this time, and finding nothing. They must remember that the IgM antibody to the virus core maybe their only clue.
‘Hepatitis B envelope Ag’ is the physician’s clinical guy to infectivity of this bug. That’s because the Hepatitis B envelope Ag means it is actively replicating. It’s an antigen right? So that means it’s new virus coming forward. Not just an antibody!
Hepatitis B s (s for surface) Ab levels imply immunity. From this, a very complicated but important discussion about nonresponders to vaccine evolves because we need to know why some people, and there’s quite a few!, don’t respond to the vaccine at all!
So we check their LAB: (-) Hepatitis B surface Ab titers after vaccine? This leads to-> repeat hepatitis B vaccine and tilters. & hepatitis B immunoglobulin (treatment!) if exposed as well!
Conclusion
Unfortunately, hepatitis B gives you “B for BOTH” again and again when there are any possibilities with regards to its transmission, infectivity, and carrier states:
Both STD/IV as well as perinatal contact
Both fulminant hepatic failure and carrier
Both perinatal and then likely carrier
Both perinatal & > older carcinoma risk
Complicated lab interpretation when it comes to hepatitis B, in general. No pneumonics there unfortunately. Just a whole lot of memorizing. But it must be done so you don’t slight folks at risk for it, or that didn’t respond to the vaccine, or that may have been exposed, or that might someday get exposed. Like docs!
