Hepatitis A and B Discrimination According to Aminotransferases

Objective: Acute infection of hepatitis A and B viruses is accompanied by biochemical evidence of liver injury. In acute symptomatic hepatitis, transaminase tests are markedly elevated, especially, in hepatitis A. This study was carried out to examine the feasibility of discrimination between hepatitis A and B in acute phase using serum transaminase concentrations so as to take isolation precautions and to plan supportive therapy in early phase. Methods: Between January 1996 and December 1998, 444 patients, [239 (53.8%) males and 205 (46.2%) females] are tested for hepatitis B surface antigen (HBsAg), hepatitis B core IgM antigen (anti-HBc IgM), and hepatitis A immunglobuline M (anti-HAV IgM), alanine aminotransferase (ALT), aspartat aminotransferase (AST) and bilirubin concentrations and comparison of transaminase concentrations between patients infected with hepatitis A and hepatitis B has been made.Results: ALT concentrations of HAV-infected patients had a median of 879 (minimum: 4, maximum: 7201), whereas HBV-infected patients had a median of 66 (minimum: 16, maximum: 3118). AST concentrations of HAV-infected patients had a median of 492 (minimum: 8, maximum: 5718), whereas HBV-infected patients had a median of 59,5 (minimum: 13, maximum: 2040). Transaminase concentrations of patients infected with hepatitis A are higher than patients infected with hepatitis B (for ALT and AST p<0,001). Also there was difference in transaminase concentration in acute hepatitis with age. Concentrations of serum transaminases in acute hepatitis increased with age and peaked at 7-8 years, having a median of 1565 (minimum: 9 and maximum: 4014) for AST and 1942 (minimum: 22 and maximum: 3950) for ALT.Conclusion: Discrimination between hepatitis A and B in acute phase using serum transaminase concentrations could be helpful to get isolation precautions and to plan supportive therapy in early phase.