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Hepatitis B is a viral infection that affects the liver and can cause both acute and chronic disease. The hepatitis B virus is transmitted through contact with infected blood or other body fluids. Common routes of transmission include from mother to child during birth, unsafe injection practices, transfusions of unscreened blood, sexual contact, and sharing of needles among drug users. Laboratory testing plays a crucial role in diagnosing hepatitis B infection, determining the stage of disease, and monitoring treatment effectiveness.

The primary laboratory tests for hepatitis B include serologic markers that detect viral antigens and antibodies in the blood. Hepatitis B surface antigen, or HBsAg, is usually the first marker to appear and indicates active infection. The presence of antibodies to the surface antigen, called anti-HBs, indicates immunity either from vaccination or recovery from infection. Hepatitis B core antibody testing helps distinguish between acute and chronic infection, with IgM antibodies suggesting recent infection and IgG antibodies indicating past exposure. Hepatitis B e antigen, or HBeAg, is a marker of high viral replication and infectivity.

Additional tests help assess the severity of liver damage and guide treatment decisions. Liver function tests measure enzymes such as alanine aminotransferase and aspartate aminotransferase, which become elevated when liver cells are damaged. Hepatitis B viral load testing, which quantifies the amount of viral DNA in the blood, is essential for monitoring disease progression and response to antiviral therapy. A complete blood count may reveal abnormalities associated with chronic liver disease, while tests measuring blood clotting factors help evaluate liver synthetic function.

For people with chronic hepatitis B, regular laboratory monitoring is important to detect progression to cirrhosis or liver cancer. Alpha-fetoprotein is a tumor marker that may be elevated in hepatocellular carcinoma, the most common type of liver cancer associated with chronic hepatitis B. Periodic testing allows healthcare providers to intervene early if complications develop. Understanding these laboratory tests helps patients and healthcare providers work together to manage hepatitis B infection effectively and prevent serious liver disease.