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Abstract: PO1208

Hep B or Not Hep B: The Mystery of Hepatitis B Serology in a Dialysis Patient

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Abusalah, Wala, Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Lefkowitz, Heather Rush, Newark Beth Israel Medical Center, Newark, New Jersey, United States
Introduction

Dialysis patients are susceptible to viral infections due to impaired cellular immunity. HepB remains a major problem in these patients. Hemodialysis, transfusions, frequent admissions and surgery, all increase risk of infections. While the introduction of vaccines and infection control measures have limited the spread of hepatitis infection within dialysis facilities, outbreaks occur and prevalence remains high. Serology testing is used to screen and identify infected patients. Interpretation of these serologies, as in our case, can be challenging.

Case Description

83 y/o female with HTN, DM and ESRD on HD. Admitted from a NH with viral prodrome and tested +ve for COVID-19.
Nephrology consult was requested for maintenance HD. She had HBsAg assay which came back positive. Full Hep B panel showed HBsAb +ve, HBcAB +ve (IgM), HepB DNA PCR –ve, HBeAg & Ab-ve. Surprisingly, old records showed HBsAg positivity 6 months prior to admission and the rest of the serology was identical to this admission. Within the last 6 months, she have had multiple HBsAg tests that all came back -ve. Up to this point, she wasnt receiving HD in dedicated HepB machines. Decision was to apply segregation and to contact the health department to trach down all patients that were dialyzed with the same machines.

Discussion

The prevalence of HepB in dialysis patients is 1%. Cirrhosis, which can result from HepB, is associated with a 35% increased mortality in dialysis patients. To prevent transmission, measures include barrier procedures, routine screening, disinfection and vaccination. Failure to use dedicated machines may increase incidence of HepB. Serology can identify infected patients. Screening consists of HBsAg, anti-HBs, and anti-HBc. Our patient’s serology was unique. Her Anti-HBs was always positive. Due to anti-HBc positivity, we believe that she was infected in the past. Interestingly, the HBc-IgM was always +ve and DNA was always -ve. The occasionally positive HBsAg is bizarre. This can be seen in patients receiving vaccination but it doesn't apply to our patient. We don’t have an explanation for positive HBsAg in the absence of DNA and there are no recommendations to guide clinicians in such cases. In our patient, we decided to consider her a chronic HepB patient for the purpose of dialysis segregation, however, she does not meet criteria for chronic HepB and will unlikely require treatment.