LQCL2504 - CMLE - Hepatic Panic: A Cautionary Tale of Occult Hepatitis B Infection-LQCL2504

LQCL2504 - Educational Activity

Pdf Summary

The document is an educational piece for clinical immunology regarding hepatitis B virus (HBV) infection, particularly focusing on serological testing and management of HBV in immunosuppressed patients. It offers learning objectives, a case study, and a detailed exploration of HBV infection, diagnosis, and management.<br /><br />The learning objectives include identifying serological markers for HBV screening, diagnosis, and monitoring, discussing new recommendations for the serologic “triple panel” test, recognizing patients at risk of occult HBV infection, and understanding HBV reactivation risks in immunosuppressed individuals.<br /><br />A case study describes a 48-year-old female with B-cell Non-Hodgkin Lymphoma who developed hepatitis after rituximab therapy, presumed to be due to occult HBV infection. The patient had initially tested negative for HBsAg and anti-HBs, but on developing liver dysfunction, subsequent tests showed a positive HBsAg and high HBV DNA levels. The case emphasizes the significance of using a "triple panel" test prior to immunosuppression to detect potential occult HBV infections, including markers such as HBsAg, anti-HBc total, and anti-HBs.<br /><br />The document explores HBV transmission, its acute (AHB) versus chronic (CHB) infection stages, serological markers, and their clinical significance. It highlights how CHB is particularly a health issue in certain high-risk groups or demographics. <br /><br />Reactivation of HBV, a severe risk in immunosuppression, especially with therapies like rituximab, can occur in those with CHB or occult infection, characterized by renewed high viral load and liver dysfunction.<br /><br />The summary underlines the importance of cooperation between clinicians and laboratory specialists in managing HBV, following new screening protocols to mitigate reactivation risks in vulnerable populations, particularly among those receiving immunosuppressive treatments. <br /><br />Overall, the document underscores the critical role of comprehensive serological testing in preempting HBV reactivation and ensuring informed clinical management of susceptible patients.

Keywords

Hepatitis B virus

serological testing

immunosuppressed patients

HBV reactivation

occult HBV infection

triple panel test

rituximab therapy

B-cell Non-Hodgkin Lymphoma

serological markers

clinical management