EXPERIMENT 15 Flashcards
Hepatitis B virus is a member of the
Hepadnaviridae family
Hepatitis B virus is a (?), with an (?) containing a rapidly (?) DNA genome.
42 mm enveloped virion
icosahedral nucleocapsid core
double stranded circular
– the only DNA virus, all other hepatitis virus is RNA.
Hepatitis B virus
The envelope contains a protein called the (?), which is important for laboratory diagnosis and immunization.
(Example, for vaccines – ?)
surface antigen (HBsAg)
Anti-HBsAg
is the earliest serological marker that indicates the presence of acute infection.
HBsAg
It is also indicative of chronic infection.
HBsAg
REAGENT:
Test kit (cassette) for HBsAg
SAMPLE:
Plasma or serum (should be free from contamination, hemolysis and lipemia)
– detecting the presence of an antigen with multiple epitopes.
Immunochromatography (Solid Phase “Sandwich” Immunoassay)
is a colloidal gold enhancement immunoassay that detects hepatitis B surface antigen in human serum or plasma.
HBsAg test
The sample initially reacts with the (?) on the sample pad.
monoclonal antibody – colloidal gold conjugate
This mixture migrates across the membrane by capillary action and reacts with the (?) in the test region.
anti-HBsAg
The HBsAg will bind to the monoclonal antibody (?) gold conjugate forming a complex.
first reagent – bread 1
The mixture of monoclonal antibody and HBsAg (palaman) present in the patient’s sample will migrate across the membrane by the capillary action and reacts with the anti-HBsAg (?) in the test region, creating a sandwich.
second reagent – bread 2
PROCEDURE:
1. Bring the kit components and specimen to (?) before testing
2. Remove the test card from the sealed foil pouch. Once opened, the test card must be (?).
3. Label the test card with(?).
4. Dispense (?) of the sample to the center of the sample well (marked as “S”)
Note: Follow the volume of the sample recommended by the manufacturer (depend on the brand)
5. Read and interpret the results
Note: Strictly follow the manufacturer’s recommended time for reading test results
room temperature
used immediately
patient’s identity
3 drops (100 µL)
Distinct colored band appears on the Test region (T) in addition to a colored band on the Control region (C)
POSITIVE (REACTIVE) (repeat testing)
No colored band appears on the Test region (T) but distinct colored band appears on the Control region (C)
NEGATIVE (NON- REACTIVE)
Neither Test (T) nor Control (C) colored band appears, or colored band only appears on the test region (T) but not on the Control region (C) The specimen should be tested again using a new device
INVALID (repeat testing)
Keywords:
hepa-
itis:
liver
inflammation
- general term for the inflammation of the liver.
Hepatitis
Hepatitis Causes:
viral infection, chemicals, ionizing radiation and autoimmune process
Two stages of inflammation:
- the patient will exhibit general flu-like symptoms
Acute stage
The patient can exhibit hepatomegaly, jaundice
Progressive stage/ chronic stage
(enlargement of the liver)
hepatomegaly
(yellowish discoloration of the skin, dark urine and light feces In the urine, since the liver cannot conjugate the urobilinogen, it will be pass out as urobilin causing dark urine.
jaundice
In light feces, since the liver has a problem, it will not convert the conjugated bilirubin into the normal color of the feces which is the (?). Since there is no (?), the feces will be light instead of the normal color which is brown
stercobilin
stercobilin
Initial laboratory tests
Elevations in bilirubin and liver enzymes (ALT)
Asymptomatic- the patient will not exhibit any signs and symptoms
ACUTE
The liver cells are destroyed.
ACUTE
Liver cirrhosis
ACUTE
Liver cancer
ACUTE
IT CAN OCCUR 6 MONTHS OR MORE
ACUTE
IT CAN OCCUR LESS THAN 6 MONTHS
CHRONIC
Joint pain
CHRONIC
Rash
CHRONIC
Vomiting
CHRONIC
Diarrhea
CHRONIC
Dark urine
CHRONIC
Yellowish color of the skin and the sclera of eyes
CHRONIC
Muscle aches
CHRONIC
Tiredness
CHRONIC
Decrease appetite and weightloss
CHRONIC
All of the genome of hepatitis virus is of RNA except (?) that is DNA.
hepatitis B
For the transmission, all of the hepatitis virus is transmitted (?), except hepatitis A and E which are transmitted (?).
parenteral, sexual, or perinatal
fecal, and oral route
For the progression to chronic state, all of the hepatitis virus can except (?) which is only in acute state
hepatitis A and E
Note: For hepatitis D, it will not exist if the patient does not
hepatis B
is a co-infection or super infection of hepatitis B
Hepatis D
For the screening test (ST) for the diagnosis of HBV, take note this is blood test particularly we use
serum
For ST most of the tests have already
high sensitivity
Category 1:
Enzyme Linked Immunosorbent Assay (ELISA)
Category 2:
Rapid test kits
- so this is what we test when it comes to screening test.
Hepatitis markers
Only (?) is NOT detectable in blood. We can detect them in biopsy.
HBcAg (Hepatitis B Core Antigen)
So in order to test for the presence of HBcAg we need to do (?). But when it comes to blood testing, it is not detectable.
liver biopsy
- done only by National Reference Laboratories (NRL) or other big hospitals that was accredited by our NRL.
Neutralization test
Take note that NRL when it comes to serological test will be
San Lazaro Hospital (RA 4688).
CONFIRMATORY TEST FOR HBV
Neutralization test
- This test is performed when we are going to monitor the course of infection for HBV or when we give treatment for patients having HBV, we need to monitor their viral load.
HBV Viral Load
MONITORING TESTS
HBV Viral Load
Real time PCR
- number of the virus that is present in our body.
Viral load
- can detect as few as 10 copies of HBV DNA per mL
Real time PCR
considered as a sensitive test for HBV
Real time PCR
What we are testing under the screening test will be the
serological markers
– it is an indicator that the patient has an active Hepatitis B infection, if the HBsAg is positive it indicates that the patient has an active Heptitis B
Hepatitis B Surface Antigen
– active hepatitis B with high degree of infectivity
Hepatitis B Envelope antigen
- antibody against core, core will not be tested but can be only detectable using biopsy
IgM anti-HBe
It indicates that the patient has current or recent Acute Hepatitis B
IgM anti-HBe
– Current or past Hepatitis B
Total anti-HBe
– recovery from hepatitis B
Anti- HBe
– Immunity to hepatits B
Anti-HBs
– Acute, atypical, or occult hepatitis B
HBV DNA
viral load may be used to monitor effectiveness of therapy
HBV DNA
– Performed hand in hand, together with clinical chemistry test.
ALT ENZYME
HBsAg -
HBeAg -
AntiHBcIgM -
AntiHBcIgG +
AntiHbe +
AntiHbs +
ALT Normal
Convalescence – the patient is healing
HBsAg -
HBeAg -
AntiHBcIgM -
AntiHBcIgG +
AntiHbe -
AntiHbs +
ALT Normal
Past HBV infection with immunity (why past? – because AntiHBc IgG and Anti-Hbs is present)
HBsAg -
HBeAg -
AntiHBcIgM -
AntiHBcIgG -
AntiHbe -
AntiHbs -
ALT Normal
Immunization with Hepatitis B vaccine