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previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},260,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Important lab markers in HAV infection.","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=0pmPwY3Xu2o",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},13.066666666666666,"\u003Cp>Elevated ALT is one sign of hepatitis A infection, but is extremely unspecific. In this video taken from our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fviral-hepatitis-lab-essentials\">Viral Hepatitis Lab Essentials\u003C\u002Fa> course, Dr Wonnerth explains the relationship between ALT, IgG, and IgM levels, how different labs test for them, and whether a positive test indicates an HAV infection in the acute, convalescence, or long-term immunity phase. \u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},14.133333333333333,"Join our Viral Hepatitis Lab Essentials course now!","\u003Cp>Lab investigations are crucial for diagnosing viral hepatic infections, but they can be tricky to interpret. See more cases of viral hepatitis in our course \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fviral-hepatitis-lab-essentials\">Viral Hepatitis Lab Essentials\u003C\u002Fa>. Taught by Dr Anna Wonnerth–Certified Family Physician and Laboratory Medicine Specialist at the Hospital of Wiener Neustadt, Austria–you'll be a viral hepatitis expert in no time.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},149.33333333333334,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00]\u003C\u002Fstrong> What blood tests are available in order to diagnose a present or past hepatitis A infection? In order to answer this question, let's take a look at our diagram. The elevated ALT is an indicator of a hepatitis A infection but it is extremely unspecific. We know that there is something wrong with the liver but there are many possible reasons for this. What we need are specific serological markers for HAV. Anti-HAV IgM is the first \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30]\u003C\u002Fstrong> serologic marker to occur. It starts rising early after symptom onset and only drops to undetectable levels, up to six months later, when the infection has cleared. So, when our patient feels they need to go to the doctor, we will already find a positive IgM in the blood. In the course of [00:00:44] infection, IgM is replaced by IgG antibodies. It is important to know that anti-HAV IgG are detectable in the blood for years and confer long-term protection against reinfection. We can also split the course of infection \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>into different phases. We can distinguish an acute phase at the beginning, which is characterized by high ALT levels, high IgM levels as well as rising IgG levels. Next, the convalescence phase, with sinking IgM but still rising IgG levels and finally a phase of long-term immunity, when the infection is cleared. When IgM has dropped below the level of detection and IgG stays detectable. The long-term immunity phase actually indicates a past infection but no active infection. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30]\u003C\u002Fstrong> Taken together, anti-HAV IgM and IgG are the most important lab parameters used to determine what phase of infection our patient is in. So, what happens in the lab? Several systems are available to test for HAV in the laboratory. There are two possible paths to start the diagnostic process, depending on which test system your lab is using. Lab 1 might use a test system, measuring first, anti-HAV IgM antibodies. Lab 2 might start a diagnostic process, by measuring \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00]\u003C\u002Fstrong> IgM and IgG, in one test system. This test is called anti-HAV. When we order hepatitis A testing in lab 1, we first get the results of anti-HAV IgM testing. This is ideal if your clinical question is whether your patient is suffering from an acute hepatitis A infection or not. If the result is positive, then you can confirm that your patient suffers from an acute hepatitis A infection. What happens if the result is negative? First of all, we can exclude an acute infection. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30]\u003C\u002Fstrong> However, we might want to get a bigger picture so we can add another test called anti-HAV. In this test system, IgM and IgG are detected. Since we already know that IgM is negative in our patient, the result of anti-HAV will shed light on the IgG status of our patient. If the anti-HAV test is positive, our patient has detectable anti-HAV IgG antibodies. That means we're looking at a patient who had either a past infection, that \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00] \u003C\u002Fstrong>has already cleared or our patient has been vaccinated against HAV. In contrast, if the anti-HAV test is negative and thus, IgM and IgG are both negative, our conclusion can only be no infection. Our patient has neither an acute infection nor has he ever been in contact with the virus or the vaccine. When we order hepatitis A testing in lab 2, we first get the results of anti-HAV testing. We have already heard that this test detects IgM and IgG in \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30]\u003C\u002Fstrong> one system. So, if this test is negative, there is no HAV infection. Neither acute nor past. If it is positive, you cannot say whether IgM or IgG are responsible for the positive result. So, our reflex test for IgM has to follow, in order to distinguish an acute infection, with positive IgM from a past infection or immunization, which is characterized by negative IgM and positive IgG. There are also tests that can measure hepatitis \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:00]\u003C\u002Fstrong> A antigen or RNA, in stool, very early in the acute phase. These tests are not commonly used, as this is of interest only in rare cases and these tests are only available in specialized laboratories. Now that we know how to interpret lab results in the context of infection phases, we can start working with some real cases.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":262,"teacherIllustration":263,"backgroundImage":264,"relativeUrl":265,"lastChanged":266,"created":267,"description":268,"relativeURL":265,"meta":269},4460,false,"Viral Hepatitis Lab Essentials","course",[259],"Infectious diseases",[261],"Anna Wonnerth, MD",2.5,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ea5-7391-411d-b4d3-e308e5741b8f","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ea6-7bb8-445a-b0cd-e247366d1ce6","\u002Fcourses\u002Fviral-hepatitis-lab-essentials","1768059492","1518554185","Lab investigations are crucial for diagnosing viral hepatic infections, but they can be tricky to interpret. 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Learn to recognize and report it with exercise stress ECG.",{"alt":291,"title":292,"size":293,"location":295},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":294,"height":294},1200,{"bucket":296,"key":297},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":299,"title":300,"relativeURL":301,"image":302,"professionLong":303,"profession":304,"weight":306},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":305},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":311,"updated":312,"published":313},1778115738,1778118425,1778118255,{"id":315,"title":316,"text":317,"image":318,"author":324,"path":326,"readDuration":327,"readDurationFormatted":328,"internal":329},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":319,"title":292,"size":320,"location":322},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":321,"height":321},600,{"bucket":296,"key":323},"\u002F2026-04\u002FC121_magazine image.png",{"id":299,"title":300,"relativeURL":301,"image":302,"professionLong":303,"profession":325,"weight":306},{"name":305},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":330,"updated":331,"published":332},1777403036,1777572381,1777412421,{"id":334,"title":335,"text":336,"image":337,"author":342,"path":351,"readDuration":352,"readDurationFormatted":284,"internal":353},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":338,"title":292,"size":339,"location":340},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":321,"height":321},{"bucket":296,"key":341},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":343,"title":344,"relativeURL":345,"image":346,"professionLong":347,"profession":348,"weight":350},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":349},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,{"created":354,"updated":355,"published":356},1776705362,1776710540,1776710541,{"seo":358,"og":360},{"title":359,"description":213},"Important lab markers in HAV infection | Medmastery",{"title":359,"description":213,"image":361},{"alt":292,"title":292,"size":362,"location":365},{"width":363,"height":364},779,393,{"bucket":296,"key":366},"\u002Fmigrated-images\u002FScreen Shot 2018-02-21 at 1.25.15 pm.png",{"id":352,"created":368,"updated":369,"published":368},1519218460,1655189586]