| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Liver failure (rapid decline in hepatic function in patients) with red flags which include:
- jaundice
- ascites
- hepatic encephalopathy
- haematemesis (e.g. variceal bleeding)
- Sepsis in a patient with cirrhosis
- Spontaneous bacterial peritonitis
- Severe ascites restricting movement and breathing or causing abdominal pain
|
| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
|
-
Deteriorating LFT (e.g. rising bilirubin, alanine aminotransferase (ALT) and/or INR) without red flags
To contact the relevant service, see Clinician Assist WA: Acute Gastroenterology assessment (external site)
|
| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
|
- Chronic Hepatitis B (HBsAg positive) patient requiring anti-viral therapy
- Cirrhosis (as determined radiologically, clinically, blood tests or elastography)
- Co-infection
- Prior antiviral treatment failure
- Pregnant women who are HBsAg positive and have HBV DNA >200 000 IU/ml
|
| Mandatory information |
|
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
|
| History |
- Relevant history, onset, duration, and severity of symptoms
- Alcohol consumption
- Current medications list
- Any known allergies
|
| Examination |
- Height and weight, or BMI
|
| Investigations |
- FBC
- U&E
- LFT (including AST)
- HBV Serology (HBsAg, anti-HBc, anti-HBs), and HBV DNA quantitative viral load
- HCV Serology
- HIV Serology
|
| Highly desirable |
| History |
|
| Examination |
|
| Investigations |
- Fibrosis-4 index panel (FIB-4) value
- INR
- Previous LFT with AST
- Alpha Fetoprotein (AFP)
- Fasting glucose and lipids
- Upper abdominal ultrasound (US)
- Previous imaging and/or liver biopsy results
- Pregnancy testing for women of childbearing age
|
| Indicative clinical urgency category |
|
Category 1
Appointment within 30 days
|
- Patients who are HBsAg positive with red flag features (i.e. evidence of liver decompensation e.g. jaundice, ascites)
- Pregnant women who are HBsAg positive and have HBV DNA >200 000 IU/ml
- Patients about to commence chemotherapy, immunosuppressants and/or treatment for tuberculosis
|
|
Category 2
Appointment within 90 days
|
- Patients who are HBsAg positive with the presence of advanced fibrosis as defined by:
- Fibrosis-4 index panel (FIB-4) score > 1.6 OR
- Hepascore > 0.5 OR
- Liver elastography score > 8 kPa OR
- Other objective evidence of liver fibrosis or ALT > 3 x ULN
|
|
Category 3
Appointment within 365 days
|
- Patients who are HBsAg positive and HBV DNA positive with a viral load ≥2000 IU/ml
- Patients who are HBsAg positive and HBV DNA positive with a viral load <2000 IU/ml who require USS surveillance (refer to Useful information)
|
| Exclusions |
- Patients who are HBsAg positive and HBV DNA viral load < 2000 IU/ml with no evidence of advanced fibrosis (not requiring USS surveillance)
- Patients who are Hepatitis B surface antigen (HBsAg) negative, unless they are immunosuppressed or starting immunosuppressant medicines
|
| Useful information |
- Hepatitis B is a notifiable disease (report within 24hours of diagnosis)
- See Clinician Assist WA - Chronic Hepatitis B
- Hep B Hub WA is a statewide clinical advice service available to all referring clinicians. The service provides guidance, support and education relating to Hepatitis B and its management for both referred and non-referred patients, as well as more general enquiries. Clinicians can contact the service by emailing HepBHubWA@health.wa.gov.au with responses given within 2 business days
- Australian consensus recommendations for the management of hepatitis B infection
- HBV DNA quantitative test: patient is eligible for one test per year under Medicare not on treatment
- For patients with no evidence of fibrosis, repeat LFTs every 6 months and viral load test every 12 months
- Fibrosis-4 calculator
- USS Surveillance recommended in:
- Africans over 20, Asian males over 40 and Asian females over 50
- Caucasian/ Indigenous patients over 50
Medical Management
- Screening and vaccination for Hepatitis A for patients
- Screening and vaccination for Hepatitis B of sexual contacts and immediate family members
- Natural history of disease, transmission risks and precautions,
- Lifelong monitoring of disease if advanced fibrosis/cirrhosis, disclosure, treatment options
- Consider lifelong monitoring of disease for hepatocellular cancer screening with 6-monthly ultrasound and Alpha Fetoprotein (AFP)
- Find an HBV community prescriber: ASHM hepatitis B S100 community prescriber map
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Last reviewed: 29-04-2025