Hep B

Question 1

If HbsAg + do the following tests

Answer 1

Hbeag 
Hbeab
Hbv dna
Lfts
Check hep a IgG

Question 2

If hbsag -, anti-hbs, anti-hbc

Answer 2

Vaccinate mother if high risk

Question 3

If hbsag detected

Answer 3

Check hbv dna

Check eAG and anti Hb-e

Question 4

If hbv >10^7, or >10^6

Answer 4

Treat w lamivudine, tenofivir, or tebivudine from 30/40
Hbig and vaccine to neonate ASAP (<12hours) 6/52,3,5mo for fu vax
Monitor for flare pp-check alt every 4 weeks for 2-3/12
F/U anti-HBs antibody and HBsAg levels at 5 months for neonate

Question 5

Exposure to hepb in pregnancy

Answer 5

Check anti-hbs
If <10, hepb vac and hbig within 72 hours of exposure with subsequent vaccinations
Repeat test of hbsag at 3 months

Question 6

Risk of transmission if HbeAg+ve

Answer 6

EAG+ve70-90% if no tx

EAG -ve 10-40% if no tx

Question 7

Hep B sAg +, eAg +, high viral load. Risk of T21 1:100 first trimester screen, 13/40

Answer 7

Arrange genetic counselling regarding options and inform genetic counselor regarding Hep B and d/w ID re treatment