EXPLAINER: Lab results and their interpretation

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491

Hi @Bigjoetx

I’m not a physician, so please take comments made by a physician over what I write.

None of these tests are specific for HBV, but the bilirubin, ALT, and AST report on general livery health. Your bilirubin is a bit high, but the ALT and AST are both normal. The ALT & AST results say you are unlikely to have ongoing extensive inflammation in the liver. I don’t know how to interpret the bilirubin value, but there are many things that can elevate that value that are unrelated to HBV.

The normal primary test for HBV is HBsAg (the viral surface protein). More detail about a potential infection comes from tests for HBV DNA, HBeAg (a variant of the viral core protein), HBcAg (the viral core protein), and antibodies against HBsAg, HBeAg, and HBcAg. Your doctor will know which tests to order.

I wish you the best.

John

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492

Hello,

Can you look at me result,
my doctor told me that is very good, what our community thinking about it?

  • HBsAg - positive (+)
  • hbv dna - 305 IU/ml
  • alt - 14 U/l
  • afp - 4.48 ng/ml
  • ast - 25 U/l
  • ultrasound - is good, without changed

I have 35 years, I vegan, dont drink alcohol etc, exercise every day triathlon, tennis etc.

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493

Hello, I’m Claire, truly grateful to find this caring, informative community. Thanks @ThomasTu @Joan_Block and all who make this place.

Briefly my situation: I’m 43, female, born in US, healthy lifestyle except for stress. Despite lots of reading I’m still confused about my situation, partly bc I’ve had results in two places and no doctor has spoken to me yet. I’m hoping someone can help me sort through what I’m facing and what to ask for, in light of gaps in care and my brain! I have an abdominal ultrasound scheduled for 8/12 following raised ALT/AST levels and some basic HBV tests that indicate exposure- after that I get lost.

This ‘started’ when I had a 102 fever in mid June, with aches and chills and stopped having to urinate until I drank buckets of water. Next week developed cough that is mostly gone now. Was not Covid as very sure as can possibly be these days.
-I thought it might be a flare bc in 2020, when living elsewhere, I got diagnosed with early/mild rheum condition- has been pretty stable since medication.
-I saw my doctor here for possible flare. He ordered panel and my relevant results were:
June 7:
ALT:196 U/L.
AST:94 U/L.
ALK Phos: 168 UL.
Albumin 4.8 g/dL.
Bil: .6g/dL.

July 29
HBVsAg: negative
HBsAB: positive (quant 443.82)

Albumin 4.3 g/dL
Bil: .3 g/dL
Bili, Indirect - one component out of range
Bili, Direct <0.2 mg/dL

I was astounded and frantically went back to 2020 bloodwork because I know rheum had been thorough but never said a word. Sure enough found:
June 2020:
HBcAB - not detected
HBsAb - 723.2 immune >9.9 IU/L
HBsAg - not detected
ALT: 13 U/L
Alk phos: 58 U/L
Albumin 53 U/L

I understand the very basic of antigen (active infection) versus antibody (past exposure/vax) but have read so many posts now my head is spinning about what tests say you have HBV and then if it is chronic etc. For instance, I saw ‘Hepatitis B core antibody (HBcAb or anti-HBc) - this tests for an exposure to the hep b virus. If it is [+] then a person has been exposed the hep b virus. If it is [-] then the person has not been exposed to the virus.’ But the HBsAb says I have exposure, yes?

If I have HBV, was this a possible ‘reactivation’ of the virus- my immune system has been off since Covid in Jan? Or maybe autoimmune? If I need more blood testing what might I focus on?

Thanks so very much for any help.
Claire

494

Dear @Leonk, welcome to the community. Your lab results show that you have a low viral load, normal US and normal ALTs. This is linked with good health outcomes. Great that you are so active, well done and keep up the good work!

Dear @ClaireLake, welcome to the forum and thank you for sharing your story. I’m sorry to hear that you have been so confused about your lab results and haven’t found any explanations.

The lab results you’ve shared indicate you’ve been vaccinated against Hepatitis B (HBsAb-positive) and that you haven’t been exposed to the virus (HBcAb-negative). You can therefore be pretty confident that you haven’t had a virus reactivation because there’s no virus there to reactivate!

Hope this helps ease your worries,
Thomas

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495

Oh wow! Yes it does relieve me greatly (zero memory of getting this vaccination though…!). Thank you so much.
Quick follow up- the raised ALT etc during that infection- that indicates liver inflammation? Do you have any suggestions on why that might have occurred?

Claire

496

Great to hear, @ClaireLake! Not a problem.

Raised ALTs can happen with other infections as well: we have previously talked about COVID infection causing this even without liver involvement (e.g., How are you dealing with COVID? - #63 by ThomasTu). It is likely true with other acute diseases as well.

Thomas

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497

Hi ancious1, I would love to connect with you. I too have a coexistence of HBsAg and hbsab and was vaccinated as a kid. Please send me a message so we can connect

498

Hello, John, thank you so much for your response. I really appreciate it! I went and did some tests, please see the image attached. I am wondering if I need to do more tests to confirm?

Thank you very much!!!

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499

Dear @Bigjoetx,

These results indicate that you have never been exposed to Hepatitis B (both HBsAg and HBcAb are negative). It would also be good to get your HBsAb levels tested to see if you need a vaccination to help protect you from any possible future exposure.

Hope this helps,
Thomas

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500

Thank you @ThomasTu . Much appreciated.

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501

Hello, please help me to understand the ultrasound results.

February 2020
Right lobe: 130 mm
Left lobe: 58 mm
Gallbladder: deformed

May 2020
Right lobe: 124 mm
Left lobe: 52 mm
Gallbladder:61x27 mm, walls 2-3mm

July 2020
Right lobe: 119 mm
Left lobe: 42 mm
Gallbladder: 56x24 mm, walls 2-3 mm

May 2021
Right lobe: 117 mm
Left lobe: 65 mm
Gallbladder:50x18 mm

March 2022
Right lobe: 115 mm
Left lobe: 70 mm
Gallbladder: 65x18 mm

502

Hi @Bigjoetx,

I’m pleased to see that your serology indicates you are not infected with HBV. I fully agree with Thomas that getting your HBsAb levels tested would be a good idea to see if your vaccine is still protecting you. If the antibody levels are low, you can get a booster vaccination to push them back up. Your doctor can help you with those things.

John.

503

Thank you! What about these results? These ones are confusing me. I was reading this and that’s where my confusion is coming from.

Any insights/thoughts, on these other results below?

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Here’s another link.

504

Dear @Bigjoetx,

My apologies, I had misread your previous post and thought it had said HBcAb total, when it said HBcAb IgM.

The results you have just posted (in addition to the initial ones) suggest that you have been exposed to Hep B but have now recovered from it. You have very high (and therefore protective) levels of HBsAb, which is great. You have loss of HBsAg, which is really indicative that you have cleared the infection and this is linked with very good health outcomes.

There is a bit of an inconsistency in that you have detectable HBeAg and HBeAb at the same time. I am not sure that this has an impact on your health at all. Can any @HealthExperts provide an opinion?

Cheers,
Thomas

505

Dear @ecky,

These seem to just be measurements of your liver and gallbladder. They don’t seem to provide much information on their own.

Thomas

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506

@ThomasTu . This explanation make so much sense because nothing is standing out in my normal routine blood work. So much helpful as they were confusing me so much. Thank you again!

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507

I agree that these are confusing. I am not a medical doctor, so this is beyond my expertise. I strongly encourage you to have a good discussion with your physician.

I wish you the best.

John.

509

Dear @ethan,

Thanks for your question. I have never heard of cirrhosis occurring that quickly and it is unlikely to be due to viral hepatitis if you are testing negative for HBsAg and HCV. I am not sure what is causing your symptoms, but it is worthwhile seeing a doctor about them specifically if it continues to bother you.

Hope this helps,
Thomas

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510

Hello,
I’ve just had my blood test results. All good.
But… I’ve checked the results myself and have noticed above average bicarbonate levels.
This is not the first time I’ve had this result.
Curious if anyone else has had the same result.
What does it mean?
Blessings

511

Thanks Thomas. I am so grateful to this community & you. I checked with doctor but not helpful answer . So i decided to do HbsAg, anti HCV (4 & 11 months post exposure) Results negative

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. LFT at 11 months Results attached . results are normal but I have a bad feeling as my i am getting bruises without any reason . Hiv results also negative . Its like a nightmare . I wanted to know more about Fibroscan . whole abdominal ultrasound can be useful ? Can I connect with someone by WhatsApp ?