This is a guideline which outlines the diagnosis and management of Hepatitis B in adults and children.
Of most importance to us, they advise that after you get a positive Hepatitis B test result back on a patient (Hepatitis B surface antigen – HBsAg), certain further tests should be done. The results of these tests should be included in the referral. This probably alters management in that previously we would probably have referred patients on at that first positive test. I would encourage people to follow local guidance on this. Remember that there is NICE guidance on when to do Hep B testing. The tests NICE advises are:
- Hepatitis B e Antigen (HBeAg) and anti-HBe
- HBV DNA level (Hepatitis B viral load)
- IgM antibody to Hepatitis B core antigen (anti-HBc IgM)
- Hep A / Hep C / Hep delta / HIV antibodies
- GGT (gamma GT)
- Clotting studies
- Liver ultrasound
The other bit of importance to us is that pregnant women who are HBsAg positive should be referred to a specialist, as they will need treatment in the third trimester to avoid vertical transmission. The rest of the guideline is aimed at specialists.