Baffled by tests results
Oct 15, 2005
Dear Doctor McGovern, My wife and I recently found out we are having a baby. After taking blood work they found that she tested positive for Heb B (HBsAg). All other tests were fine. The doctor was pretty confident it was a false positive, due to her not falling into one of the high risk categories as well as the fact that I have been vaccinated.
So, she immediately took another test. (In the meantime, I took blood work to make sure I was properly vaccinated and immune. My results came back fine as all my titers are where they are supposed to be.) Her results came back as follows:
HBsAg Non reactive Anti-Hbs Non reactive IgM Non reactive HBeAg Non reactive Anti-HBe Non reactive Viral DNA 9,321 Liver test Normal
Our doctor was completely baffled and suggested we see a liver specialist. We went to the liver specialist and he felt she might have occult Hep B, but he retook her blood work (this being her third test in five weeks) and everything came back clear. All of the above was retaken and there are no signs anywhere.
Now he feels it could either be 1. bad tests (considering nothing gels together) or 2. her infection is so minimal that it does not come up on certain tests. Considering NONE of her tests make sense, what would you conclude? Just to play it safe we are testing her for the fourth time before she gives birth.
Just for my mental state (last question) Since I was properly vaccinated, could there be a chance I transmitted this to her at some point?
Looking forward to your response.
Response from Dr. McGovern
I on occasion will see some blood tests that do not "make sense" and on repeat the labs all fit together.
1. On the first round, your doctor was right in pointing out that the labs didn't make sense since she was not at risk for hepatitis. 2. You couldn't transmit the virus to her; there is no sign of chronic infection and you were vaccinated. 3. The second set of tests also don't make sense since the DNA test is positive and the surface antigen is negative. There are some RARE case reports of patients losing hepatitis B surface antigen production, but this also doesn't make sense since... 4. The last set of tests is completely negative. 5. In cases like these, I sometimes call the Laboratory director and discuss the results directly with him or her. They can sometimes go back to the original testing and see if something was recorded improperly.
I agree with your doctor who first said that the laboratories don't make sense. The only reason they were done in the first place was because she was pregnant. In this setting we have to consider the fact that sometimes tests can give a false positive reading in a patient who is very low risk. That is the problem with doing a test in a low risk patient - you run the risk of getting a false positive.
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