Hepatitis A laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]


Hepatitis A cannot be differentiated from other types of viral hepatitis on the basis of clinical or epidemiologic features alone. Laboratory tests are required for its diagnosis. Serologic tests in hepatitis A virus (HAV) infection reveal elevated IgM anti-HAV in the acute phase (gold standard) in addition to an elevated IgG anti-HAV that remains elevated for the person's lifetime. Additional laboratory findings include the detection and sequencing of HAV RNA, an elevated direct bilirubin, and elevated liver enzymes. Liver biopsy has a minimal role in the diagnosis of HAV infection and it is only used when the diagnosis is unclear or when relapse is suspected.

Laboratory Findings

Serologic Tests

Serologic testing to detect immunoglobulin M (IgM) antibody to the capsid proteins of HAV (IgM anti-HAV) is required to confirm the diagnosis of acute HAV infection.

  • Is the gold standard for the detection of acute illness.
  • Becomes detectable 5-10 days before the onset of symptoms and can persist for up to 6 months after infection
  • Does not always indicate acute infection in asymptomatic adults. IgM anti-HAV can be present in the following cases:
  • Appears early in the course of infection
  • Remains detectable for the person's lifetime, conferring protection against reinfection
  • Confers lifelong protection against the disease

Two serologic tests are licensed for the detection of antibodies to HAV:

In the majority of patients, IgM anti-HAV declines to undetectable levels less than 6 months after infection. However, persons who test positive for IgM anti-HAV, more than 1 year after infection have been reported, as have likely false-positive tests in persons without evidence of recent HAV infection.

Total anti-HAV testing is used in epidemiologic studies to measure the prevalence of previous infection or by clinicians to determine whether a person with an indication for pre-exposure prophylaxis is already immune.

Sensitive tests for immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-HAV in saliva have been developed but are not licensed in the United States.

Electron Microscopy

Liver Function Tests

Liver enzymes such as aminotransferase and alkaline phosphatase, along with direct bilirubin are commonly elevated among patients with Hepatitis A:[5]

Other Laboratory Findings

Shown below is an image depicting the course of change of the serum concentration of serum IgG, IgM and ALT following hepatitis A virus infection.

Liver Biopsy

The role of a liver biopsy is minimal in the diagnosis of hepatitis A. It may be used in cases involving chronic relapsing hepatitis A or when the diagnosis is unclear.


  1. Bower WA, Nainan OV, Margolis HS. Duration of viremia in naturally-acquired hepatitis A viral infections. [Abstract 103] In: Abstracts of the Infectious Diseases Society of America 35th Annual Meeting. Alexandria, VA: Infectious Diseases Society of America, 1997.
  2. Liaw YF, Yang CY, Chu CM, Huang MJ (1986). "Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak". Infection. 14 (4): 156–8. PMID 3759243. |access-date= requires |url= (help)
  3. Stapleton JT (1995). "Host immune response to hepatitis A virus". The Journal of Infectious Diseases. 171 Suppl 1: S9–14. PMID 7876654. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  4. Hutin YJ, Pool V, Cramer EH, Nainan OV, Weth J, Williams IT, Goldstein ST, Gensheimer KF, Bell BP, Shapiro CN, Alter MJ, Margolis HS (1999). "A multistate, foodborne outbreak of hepatitis A. National Hepatitis A Investigation Team". The New England Journal of Medicine. 340 (8): 595–602. doi:10.1056/NEJM199902253400802. PMID 10029643. Retrieved 2012-02-28. Unknown parameter |month= ignored (help)
  5. Tong MJ, el-Farra NS, Grew MI (1995). "Clinical manifestations of hepatitis A: recent experience in a community teaching hospital". The Journal of Infectious Diseases. 171 Suppl 1: S15–8. PMID 7876641. Retrieved 2012-03-08. Unknown parameter |month= ignored (help)

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