Document Detail


Multiple factors contribute to positive results for hepatitis a virus immunoglobulin m antibody.
MedLine Citation:
PMID:  23276180     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Context.-In the United States, a successful vaccination program for hepatitis A virus (HAV) infection has decreased both its incidence and the true positive rate for diagnostic immunoglobulin M (IgM) antibody to HAV in acute hepatitis. Objective.-To survey positive results of HAV IgM tests and determine the effect of changing ordering options. Design.-We reviewed all positive results for IgM antibody to HAV between January 2007 and December 2010. Patient demographics, clinical history, and laboratory data were recorded and the encounter, order, and reason for test reviewed. Each result was categorized as indicating acute, recent, resolved, or indeterminate HAV infection. Results.-A total of 10 735 tests were performed; 35 patients had 49 positive results. Most positive test results were associated with outpatient visits and were ordered in the assessment of patients with liver disease, but not clinical acute hepatitis. In the final analysis, 4 patients had acute hepatitis A and 20 individual patients had recent and/or resolved hepatitis. All but 1 of the remaining 11 patients had another established cause of liver disease with a positive IgM HAV antibody test result; data to determine causality were insufficient. The total number of tests requested annually decreased more than 35% with the introduction of computerized physician order entry. Conclusions.-Current assays for IgM HAV antibodies are overused in the absence of clinical acute hepatitis; future clinical decision support may improve patterns of order entry. Most patients have findings consistent with HAV exposure but not acute hepatitis; dormant viral infection may be a continuing source of antigen.
Authors:
Adnan Alatoom; M Qasim Ansari; Jennifer Cuthbert
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pathology & laboratory medicine     Volume:  137     ISSN:  1543-2165     ISO Abbreviation:  Arch. Pathol. Lab. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7607091     Medline TA:  Arch Pathol Lab Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  90-5     Citation Subset:  AIM; IM    
Affiliation:
From the Department of Pathology, University of Texas Southwestern Medical Center, Dallas.
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