Other investigations to consider in general practice, before referral, if hepatitis C antibody positive

The following investigations can be offered in primary care to all positive patients before referring them. Practitioner's preference may cause these tests to be carried out in specialist centres.

• HCV RNA to test for active infection in the blood
• full blood count (FBC) including differential to check for anaemia, neutropenia etc, low platelets and signs of high alcohol consumption etc
• urea and electrolytes (U+E), creatinine and calcium
• liver function tests (LFT) - such as alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) (these indices are not good indicators of liver damage or the severity of the HCV infection)
• glucose
• thyroid function tests (TFT) - since treatment with interferon may lead to thyroid dysfunction (hyper or hypo thyroidism)
• ferritin - to check if the iron stores are elevated in patients with CHC
• investigations for hepatitis B infection
  • hepatitis B surface antigen (HBsAg, also known as Australian Antigen, which signifies presence of HBV);
  • hepatitis B core antibody (HBcAb or Anti-HBc, which indicates acute or chronic infection)
  • hepatitis B surface antibody (HBsAb or Anti-HBs which indicates antibodies to the surface and if positive means that the person is immune to hepatitis B (from either having had the disease or from having been given the vaccine); and
  • antibodies to 'e' (Anti-HBe) which indicates low infection rate and probable recovery
• hepatitis A, if not done previously as any other form of hepatitis can be detrimental to hepatitis C
• HIV antibody test, even if they previously tested negative as HIV is currently increasing in injecting drug users (1)

Reference:

• 1. Royal College of General Practitioners (RCGP) 2007.Guidance for the prevention, testing, treatment and management of hepatitis C in primary care ongoing management in primary care