Oct 29, 2005
Dear Doctor McGovern, I recently wrote you regarding my wife's blood work and you were kind enough to write back. Your email was very much a comfort. If you recall, my wife is pregnant and after routine blood work a test came back stating she is positive for HBsAg. The doctor was convinced this was a false-positive and gave her another test. The second test came back HBsAg Non reactive Anti-Hbs Non reactive IgM Non reactive HBeAg Non reactive Anti-HBe Non reactive Viral DNA 9,321 Liver test Normal. Again, he was baffled so he referred us to a liver doctor. The liver doctor retested her (this is her third test) and everything came back clear -- a clean slate.
The liver doctor feels 1.bad tests (considering nothing gels together) or 2. her infection is so minimal that sometimes it comes up on tests (when it flares) and sometimes it does not.
My question is -- could hepatitis B be so minimal that sometimes it comes up on tests and sometimes it does not? We are so worried and I have done so much research, but can't find any information that comes close to this situation.
Perhaps they were bad tests, but what is the probability of two separate tests having some kind of indication of hepatitis b -- even if none of the tests gel together?
Please note, I also contacted the American Red Cross regarding her blood work and the Laboratory responded stating the DNA test is "uniquely vulnerable to lab contamination."
Your expertise would be very much appreciated. Kind regards.
**PREVIOUS EMAIL FOR YOUR REFERENCE.
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.
Response from Dr. McGovern
Yes I can understand how troubling this has been for both of you. A confirmatory test for hepatitis B surface antigen is supposed to be done before the test is released. I think the first one would have proven to be a false positive as well. I still suspect that this is a false positive result (the DNA), particularly since she is not at risk.
In addition, you should also discuss this issue with your pediatrician and obstetrician. Dr. M
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