Approach to the Patient with Positive Hepatitis B Surface Antigen

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No further blood work is necessary. The finding of positive HBsAg alone is enough to define the patient as a chronic hepatitis B carrier, and he should be screened for hepatocellular carcinoma with a serum alpha-fetoprotein measurement and abdominal ultrasound.

This answer is incorrect. Although screening for hepatocellular carcinoma in a patient with a new diagnosis of chronic hepatitis B infection is reasonable, this patient's stage of hepatitis B infection has not yet been adequately defined and thus other serologic tests should first be performed to better characterize the stage of hepatitis B infection.

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	The next appropriate blood test is a hepatitis B core antibody (anti-HBc), which alone can determine if the patient has acute hepatitis B infection.
	The most appropriate blood test is a hepatitis B e antigen (HBeAg), which alone can determine if the patient is an inactive carrier of hepatitis B or if he is actively infected.
	Appropriate laboratory studies should include a complete hepatitis B serologic evaluation, a serum HBV DNA level, and biochemical markers related to hepatic inflammation and function.

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