Hepatitis is considered to be a major public health issue. Viral hepatitis infects and kills millions of people annually. Autoimmune hepatitis accounts for about 6% of liver transplantation in the United States. An estimated five million Americans have alcoholic hepatitis. (8) 

This article delves into the critical role of routine laboratory tests for patients living with hepatitis, shedding light on the key parameters that healthcare providers should regularly order to ensure optimal patient care and well-being. 

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What Is Hepatitis?

Hepatitis is a medical condition characterized by inflammation of the liver. Various factors, including viruses, alcohol consumption, certain medications, toxins, and autoimmune diseases, can cause it. In the United States, viral hepatitis, caused by hepatitis A, B, and C viruses, is the most frequent cause of hepatitis.

Hepatitis severity varies based on its underlying causes, ranging from mild and acute cases to severe conditions necessitating a liver transplant. Hepatitis is categorized into two main types, acute and chronic, depending on how long the liver remains inflamed or damaged. If liver inflammation persists for less than six months, it's considered acute hepatitis; if it lasts more than six months, it's termed chronic hepatitis. Acute hepatitis typically resolves on its own but can sometimes progress to fulminant liver failure, depending on its origin. Conversely, chronic hepatitis can lead to substantial liver damage and complications, including fibrosis, resulting in significant health issues and increased mortality risk. (8) 

What Causes Hepatitis?  

Viral hepatitis is the most common form of hepatitis caused by hepatitis viruses A, B, C, D, and E. These viruses are transmitted through different routes, such as contaminated food and water (hepatitis A and E), blood and bodily fluids (hepatitis B, C, and D), and sexual contact or from mother to child during childbirth (hepatitis B and C). Each type of viral hepatitis presents unique challenges, from the acute and self-limiting nature of hepatitis A to the potential for chronic infections leading to cirrhosis and liver cancer in the case of hepatitis B and C. (15) 

Non-viral hepatitis encompasses many causes, including excessive alcohol consumption, exposure to toxic substances (e.g., drugs and chemicals), metabolic disorders, and fatty liver disease. Chronic alcohol abuse can lead to alcoholic hepatitis, while toxins like acetaminophen overdose can result in drug-induced liver injury. Metabolic disorders like Wilson's disease or hemochromatosis can also contribute to hepatitis. Additionally, non-alcoholic fatty liver disease (NAFLD) has become a significant concern, often associated with obesity and metabolic syndrome, and can progress to non-alcoholic steatohepatitis (NASH) and cirrhosis over time. Finally, autoimmune hepatitis occurs when the body's immune system mistakenly attacks the liver, causing inflammation and damage.

Hepatitis Symptoms

The symptoms of hepatitis can vary depending on the underlying cause and severity of inflammation, but may include: 

• Fatigue and malaise
• Right upper quadrant abdominal tenderness
• Hepatomegaly (liver enlargement)
• Abdominal pain
• Fluid retention and abdominal swelling
• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine
• Pale stools
• Nausea 
• Vomiting 

What Are the Benefits of Regular Lab Testing for Patients With Hepatitis?

Regular lab testing is crucial in managing hepatitis by providing essential information for diagnosis, monitoring, and treatment adjustment. It allows healthcare providers to accurately diagnose the underlying cause of hepatitis to tailor treatment approaches that address the specific etiology. This optimizes patient care and improves long-term outcomes, ultimately contributing to the overall health and well-being of individuals with hepatitis.

Top Labs to Run Bi-Annually on Patients With Hepatitis

Patients with hepatitis require regular monitoring through laboratory tests to assess their liver function, the progression of the disease, and potential complications. While the specific tests needed may vary based on the type and stage of hepatitis, as well as individual patient factors, here are some of the top laboratory tests that are typically recommended for patients with hepatitis:

Liver Function Tests

These tests include markers like alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and bilirubin. LFTs help assess how well the liver is functioning and if there is any ongoing liver damage.

Viral Hepatitis Panel

A viral hepatitis panel, also known as a hepatitis panel or viral hepatitis serology, is a blood test that checks for the presence of various hepatitis viruses and specific antibodies associated with these viruses. It helps healthcare providers diagnose and differentiate between different types of viral hepatitis, primarily hepatitis A, hepatitis B, and hepatitis C.

For patients with chronic hepatitis B or C, monitoring viral load levels is essential to gauge the activity of the virus and assess the effectiveness of antiviral treatment. This test helps determine if the virus is being successfully suppressed.

Complete Blood Count (CBC)

A CBC measures the number and types of blood cells, which can be affected by hepatitis or its treatment. It helps detect conditions like anemia or a decrease in platelets.

Comprehensive Metabolic Panel (CMP)

Hepatitis can affect kidney function, so tests like serum creatinine and glomerular filtration rate (GFR) should be monitored to assess renal health. Markers of kidney function are included on a CMP. 

Immunization Status & Coinfections

Ensuring that patients are up-to-date with hepatitis A and B vaccinations is essential, especially if they are at risk of exposure.

Patients with hepatitis are at higher risk of coinfection with HIV, so regular HIV testing may be recommended (7). 

Coagulation Panel

Tests like prothrombin time (PT) and international normalized ratio (INR) help evaluate the blood's ability to clot, which can be impaired in advanced liver disease.

Alpha-Fetoprotein (AFP) 

AFP is a tumor marker that can be elevated in patients at risk of hepatocellular carcinoma (liver cancer), especially in those with chronic hepatitis. Regular AFP monitoring can aid in early cancer detection.

Vitamin D

Vitamin D deficiency is common in patients with chronic liver disease and can adversely affect bone health and overall well-being (6). 

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Summary

In managing patients with hepatitis, regular monitoring through laboratory tests is essential to track the progression of the disease, assess liver function, and detect potential complications. This article highlights the significance of specific laboratory tests to be conducted bi-annually for hepatitis patients, including liver function tests, viral load assessments, complete blood counts, kidney function tests, alpha-fetoprotein screening, and hepatitis serology. These tests help healthcare providers tailor treatment plans, adjust medications as needed, and identify early signs of liver damage or hepatocellular carcinoma. Routine laboratory monitoring plays a crucial role in ensuring the overall health and well-being of individuals living with hepatitis.