University of Guyana

Hepatitis B

Immunohematology/ Romario Harris

Blood Banking Richard Layne
Course Code: DMT Ramesh Narine
4107 Crastal Wall
Lecturer: Dr. P. Lewis
 Presentation Outline
• Overview
• Epidemiology
• Viral characteristics
• Transmission/Pathogenesis
• Signs and symptoms
• Testing and diagnosis
• Treatment/Prevention
• References
 Overview
• Hepatitis ( Hepato-Liver) (titis- inflammation)
• Hepatitis B is a liver disease caused by the
hepatitis B virus (HBV): the virus can cause
both acute and chronic hepatitis, ranging in
severity from a mild illness lasting a few
weeks to a serious, lifelong illness.
• Hep B is the most wide spread of the hepatitis
virus and causes the most important viral
hepatitis. • A partially double-stranded DNA
• Hepatitis B is a major cause of liver cancer virus
using liver cells to create copies of itself, • Genus: Orthohepadnavirus
killing those cells in the process. • Family: Hepadnaviridae
 Epidemiology
• 1/3 of the world’s population had been
Infected
• 350 million with chronic disease
• 15-25% of these die due to liver related
diseases
• 1 million deaths annually
• United States
- 1.25 million chronic carriers
- 5000 deaths annually

Reprinted from https://bestpractice.bmj.com/topics/en-gb/127

 Viral Characteristics
Characteristics:
•Lipid Envelope
•Icosahedral nucleocapsid
•ds DNA
•DNA polymerase
Surface protein antigens
•HBsAg – Hepatitis B Surface Antigen a.k.a.
Australia antigen.
•HBcAg – Hepatitis B core Antigen a.k.a. Core
antigen.
•HBeAg – Hepatitis B early Antigen a.k.a.
Early antigen. Reprinted from www.oligotherapeutics.org/to-hepb-or-not-to-hepb/
Viral Characteristics
Cont’d
 Transmission
Source of transmission
Blood
Body Fluids
Commonly transmitted through:
Injecting drugs
Transfusion of unscreened blood and
blood products
Sexual practices that lead to exposure
to blood (for example, among men who
have sex with men, particularly those
with HIV infection.
Mother to child
http://slideplayer.com/9417010/28/images/16/Transmission+of+Hepatitis+B+Infection.jpg
Pathogenesis
The HBV replication cycle

1. Attachment- binds 4. Replication- new copies

the target cells of the genome

2. Entry- virus enters

5. Assembly- formation of progeny
through clathrin-mediated
virions released from the cell to
endocytosis
produce even more copies.

6. Release- mRNA is then transported

3. Uncoating- the positive-
back to the cytoplasm where the virion
strand RNA genome is
P protein synthesizes DNA via its
released into the cytoplasm.
reverse transcriptase activity
Replication Cycle of
HBV

Reprinted from https://www.semanticscholar.org/paper/Overview-of-hepatitis-B-viral-replication

Retrieved from: https://www.researchgate.net/publication/306104456_Roles_of_hepatocyte_nuclear_factors_in_hepatitis_B_virus_infection
Clinical Manifestations
• 70-80% of people experience NO
symptoms
• Jaundice (Yellowing of skin or whites of
eye, and brown or orange urine.)
• Light-colored faeces
• Fever
• Fatigue that persists for weeks or months
• Stomach trouble like loss of appetite,
nausea, and vomiting
• Belly pain
 Types of Hepatitis
Acute Hepatitis
Chronic Hepatitis
 It’s a short-term illness that occurs
with the first 6 months after
 Is a long-term illness that occurs
someone is exposed to the
when the hepatitis B virus remains
Hepatitis B virus. For most people,
in a person’s body. Hepatitis B
acute infection leads to chronic
virus infection can last a lifetime
infection.
and lead to serious liver problems,
 Incubation period: ranges from 2 including cirrhosis or liver cancer.
weeks to 6 months.
Progression of Hep B

https://depositphotos.com/162547056/stock-photo-liver-disease-progression-in-hepatitis.html
Stages of Hep B
 Testing and Diagnosis

HBV infection is diagnosed as

follows:
1.LFTs (AST, ALT & GGT)
2.Serological test kit Testing for
specific antigens and antibodies to
the Hep b virus )
HBsAg and Hep B core antibody
(anti HBc- IgM)
Chronic- HBsAg + negative IgM
anti HBc)
Testing and Diagnosis
Cont’d
Examples
Examples cont’d
 Treatment
• The good news is that there is a vaccine • Hepatitis B infection is treated
for hepatitis B, unlike hepatitis C. with antiviral medications intended
to clear the virus from your body.
• Infection with HBV does not always
The purpose of using medications to
require treatment, as the immune treat Hepatitis B is to:
response in some people will clear the
• Clear the Hepatitis B virus from
infection. However, when HBV your bloodstream
infection becomes chronic, treatment is
• Slow down progression of
necessary. inflammation and scarring of
• The goal of hepatitis B treatment is cure. your liver
• Reduce the chances of
developing cirrhosis and liver
cancer
 Treatment Cont’d
Treatment for chronic hepatitis B may be required for the
rest of the patients life and include:
•Antiviral medications- including entecavir, tenofovir,
lamivudine, adefovir and telbivudine,
• Interferon injections- interferon alpha-2b (intron A) is a
man-made version of a substance produced by the body to
fight infection.
•Liver Transplant- if liver damage is severe by virus
invasion

https://www.hepatitisc.uw.edu/page/treatment/drugs/peginterferon-alfa-2b-drug
 Preventions
The following precautions should be taken seriously:
•Vaccination
•Never share needles
•Avoid direct exposure to blood or blood products
•Don’t personal care items in the laboratory setting
•Choose tattoo and piercing parlors carefully, make sure a
new needle is used.
•Practice safe sex
•Avoiding alcohol and drug that can damage the liver, it
may help slow the rate of progression of the disease.
 References
• 1. Batra S. HEPATITIS B VIRUS (HBV) - MORPHOLOGY, TRANSMISSION,
CLINICAL FEATURES & LABORATORY DIAGNOSIS | MICROBIOLOGY NOTES
[Internet]. PARAMEDICS WORLD. 2018 [cited 8 August 2019]. Available from:
https://paramedicsworld.com/hepatitis-viruses/hbv-hepatitis-b-virus/medical-
paramedical-studynotes#.XUzbgehKhPY
• 2. CEVHAP - A Brief History of Hepatitis [Internet]. Cevhap.org. 2012 [cited 8 August
2019]. Available from: http://cevhap.org/index.php/en/about-viral-hepatitis/a-brief-
history-of-hepatitis
• 3. Felson S. Understanding Hepatitis B [Internet]. WebMD. 2018 [cited 8 August 2019].
Available from: https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b#5