Hepatitis C Antibody

Synonym/acronym: HCV serology, hepatitis non-A/non-B.

Common use

To test blood for the presence of antibodies that would indicate a past or current hepatitis C infection.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Enzyme immunoassay, branched chain DNA [bDNA], polymerase chain reaction [PCR], recombinant immunoblot assay [RIBA]) Negative.

Description

The hepatitis C virus (HCV) causes the majority of bloodborne non-A/non-B hepatitis cases. Its primary modes of transmission are parenteral, perinatal, and sexual contact. The virus is thought to be a flavivirus and contains a single-stranded RNA core. The incubation period varies widely, from 2 to 52 wk. Onset is insidious, and the risk of chronic liver disease after infection is high. On average, antibodies to hepatitis C are detectable in approximately 45% of infected individuals within 6 wk of infection. The remaining 55% produce antibodies within the next 6 to 12 mo. Once infected with HCV, 50% of patients will become chronic carriers. Infected individuals and carriers have a high frequency of chronic liver diseases such as cirrhosis and chronic active hepatitis, and they have a higher risk of developing hepatocellular cancer. The transmission of hepatitis C by blood transfusion has decreased dramatically since it became part of the routine screening panel for blood donors. The possibility of prenatal transmission exists, especially in the presence of HIV coinfection. Therefore, this test is often included in prenatal testing packages. Currently, nucleic acid amplification testing (NAAT) is the only way to document the presence of ongoing infection. PCR and bDNA methods are recognized by the Centers for Disease Control and Prevention (CDC) as appropriate supplemental testing for the confirmation of anti-HCV antibody.

This procedure is contraindicated for

N/A

Indications

Assist in the diagnosis of non-A/non-B viral hepatitis infection
Monitor patients suspected of HCV infection but who have not yet produced antibody
Routine prenatal testing
Screen donated blood before transfusion

Potential diagnosis

Positive findings in:

Patients currently infected with HCV
Patients with a past HCV infection

N/A

Critical findings

N/A

Interfering factors

Drugs that may decrease hepatitis C antibody levels include interferon.

Nursing Implications and Procedure

Potential nursing problems

Problem	Signs & Symptoms	Interventions
Knowledge (Related to new condition or diagnosis; lack of familiarity or understanding with disease and treatment)	Lack of interest or questions; multiple questions; anxiety in relation to disease process and management	Teach the process of disease transmission, sharing needles with infected persons, unprotected sex with an infected person, sharing blood or body fluid with an infected person, blood products from an infected person; assess the patient's and family’s knowledge of the disease, transmission, and treatment; assess for cultural, literacy, or vision and hearing concerns that would interfere with learning; explain that adequate nutrition and rest can prevent disease complications; demonstrate proper hand-washing technique with re-demonstration; emphasize vigilant hand washing; discuss the implications of the disease as related to future blood donations (not possible); discuss safe sex; explain that razors, toothbrushes, and other personal care items should not be shared
Infection (Related to unprotected sex; exposure to blood and body fluids of an infected person; sharing needles with an infected person)	Fever; fatigue; loss of appetite; jaundice; nausea and vomiting; dark-colored urine; abdominal pain; stool that is clay colored; joint pain; there may be no symptoms with chronic disease	Explain that the best treatment is adequate rest, good nutrition, and adequate fluid intake; administer prescribed interferon and ribavirin for chronic hepatitis
Fatigue (Related to decreased energy secondary to liver dysfunction associated with disease process and resulting inadequate absorption, metabolism, and storage of nutrients)	Decreased concentration; increased physical complaints; inability to restore energy with sleep; reports of being tired; inability to maintain normal routine	Assess for physical cause of fatigue; pace activities to preserve energy stores; rate fatigue on a numeric scale to trend degree of fatigue over time; identify what aggravates and decreases fatigue; assess for related emotional factors such as depression; evaluate current medications in relation to fatigue; assess for physiologic factors such as anemia
Nutrition (Related to the inability to adequately store or metabolize foods; lack of appetite; refusal to eat; nausea and vomiting)	Unintended weight loss; pale dry skin; dry mucous membranes; documented inadequate caloric intake; subcutaneous tissue loss; hair pulls out easily; paresthesias	Record accurate daily weight at the same time each day with the same scale; obtain an accurate nutritional history; assess for nausea and administer prescribed medication; assess attitude toward eating; promote a dietary consult to evaluate current eating habits and best method of nutritional supplementation; develop short- and long-term eating strategies; monitor nutritional laboratory values such as albumin, transferrin, red blood cells (RBC), white blood cells (WBC), and serum electrolytes; encourage cultural home foods; provide a pleasant environment for eating; alter food seasoning to enhance flavor; provide parenteral or enteral nutrition as prescribed; encourage appropriate use of recommended vitamin supplements

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist in evaluating for hepatitis infection.
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
Obtain a history of the patient’s hepatobiliary and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a history of IV drug use, high-risk sexual activity, and occupational exposure.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Nutritional Considerations: Dietary recommendations may be indicated and will vary depending on the type and severity of the condition. Explain the importance of providing an adequate daily fluid intake of at least 4 L. Monitor the patient’s weight, intake, and output each day, and assess for development of ascites. Elimination of alcohol ingestion and a diet optimized for convalescence are commonly included in the treatment plan. As a general rule, small, frequent meals that are high in carbohydrates and low in fat will provide the required energy while not burdening the inflamed liver.
Cultural and Social Considerations: Recognize anxiety related to test results, and be supportive of impaired activity related to lack of neuromuscular control, perceived loss of independence, and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Counsel the patient, as appropriate, regarding the risk of transmission and proper prophylaxis. Stress the importance of hand hygiene to prevent transmission of the virus. Interferon alfa was approved in 1991 by the U.S. Food and Drug Administration for use as a therapeutic agent in the treatment of chronic HCV infection.
Inform the patient that positive findings must be reported to local health department officials, who will question him or her regarding sexual partners.
Cultural and Social Considerations: Offer support, as appropriate, to patients who may be the victims of rape or other forms of sexual assault, including children and elderly individuals. Educate the patient regarding access to counseling services. Provide a nonjudgmental, nonthreatening atmosphere for a discussion during which the risks of sexually transmitted diseases are explained. It is also important to discuss the problems that the patient may experience (e.g., guilt, depression, anger).
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
Patient Education
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Provide contact information, if desired, for the CDC (www.cdc.gov/vaccines/vpd-vac) and (www.cdc.gov/DiseasesConditions).
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- Knowledge
- States understanding that this disease can lead to liver scarring and liver cancer.
- States understanding that this disease can last a lifetime and may result in liver transplant.
- Skills
- Avoids situations where there can be exposure to infected blood
- Takes precautions to avoid infecting others
- Attitude
- Accurately relates that it is possible that this disease may be present without significant symptoms
- Complies with recommendation to eat several small meals a day to support adequate nutrition

Related Monographs

Related tests include ALT, ALP, antibodies, antimitochondrial, AST, bilirubin, biopsy liver, Chlamydia group antibody, cholangiography percutaneous transhepatic, culture anal, GGT, hepatitis B serology, hepatobiliary scan, HIV serology, liver and spleen scan, syphilis serology, and US liver.
Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.

Hepatitis C Antibody