Patient comes for blood donation but he has HBs Ag and HBeAg positive, and serum transaminases level is normal. What would be the next step in management?
**Core Concept**
The patient is a hepatitis B virus (HBV) carrier, as indicated by the presence of HBsAg and HBeAg. HBV infection can lead to acute or chronic liver disease. In this scenario, the patient's normal serum transaminases levels suggest that he may not be experiencing significant liver inflammation at the moment.
**Why the Correct Answer is Right**
The presence of HBeAg indicates viral replication and infectivity. However, the normal serum transaminases levels suggest that the liver is not currently inflamed. Therefore, the next step in management would be to assess the patient's liver disease activity and potential for progression. This can be done through liver biopsy or non-invasive tests such as transient elastography (FibroScan).
**Why Each Wrong Option is Incorrect**
**Option A:**
This option is incorrect because deferring donation based on HBV status alone is not sufficient, as the patient's liver function is normal.
**Option B:**
This option is incorrect because immediate antiviral therapy is not indicated in this scenario, as the patient's liver function is normal and there is no evidence of significant liver disease.
**Option C:**
This option is incorrect because deferring donation is not a management plan, and further evaluation is required to assess the patient's liver disease activity.
**Clinical Pearl / High-Yield Fact**
In patients with chronic HBV infection, the presence of HBeAg or HBV DNA levels >20,000 IU/mL indicates viral replication and a higher risk of liver disease progression.
**Correct Answer:** C. Further evaluation is needed to assess liver disease activity.