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A cost-effective diagnostic workup of patients with possible acute viral hepatitis is the most reasonable approach. Because 75% of cases of acute viral hepatitis result from infection with either HAV or HBV, the initial laboratory investigation should include serologic tests to exclude HAV or HBV. If the results of these studies are negative, further testing should be done to rule out acute HCV infection, which is less common. Serum HCV RNA is detectable 1 to 2 weeks after the onset of infection, whereas anti-HCV can be detected 8 to 10 weeks following infection with the virus. In clinically stable patients, waiting and checking the presence of antibodies to HCV may be plausible. Checking for HCV RNA by polymerase chain reaction in all patients is not cost-effective, unless there is a known history of blood exposure. Finally, not all acute hepatitis is viral. If the initial evaluation fails to show viral hepatitis, then other causes of hepatitis, such as alcoholic hepatitis, drug toxicity, autoimmune hepatitis, or Wilson’s disease, should be considered. Continue reading “Cost-Effective Laboratory Evaluation of Acute Viral Hepatitis”