Body Fluid Exposures Workup

Updated: Jun 19, 2019
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Approach Considerations

Testing for HBV surface antigen, HCV, and HIV is recommended at the time of injury. This is useful primarily as a baseline evaluation, because patients will not have undergone seroconversion in such a short time frame. Accurate results from rapid HIV tests can be available within 30 minutes, and new-generation HIV tests can detect HIV seroconversion much earlier than the standard enzyme-linked immunoassays (ELISA).

Although a number of states require written informed consent for HIV serologic testing, in the event that a patient is unable to provide consent, some institutions allow surrogates to sign. Surrogates may be family members, legal guardians, or 2 attending physicians. When a source patient refuses to consent, some states waive the required informed consent.

Many clinicians obtain routine laboratory evaluations, such as a complete blood cell (CBC) count and chemistries including liver function tests, which likely are not of much value acutely but are important as baseline values. However, sending rapid plasma reagent (RPR) to test for latent syphilis is prudent.

Women of child-bearing age should be tested for pregnancy, since the result may affect which HIV PEP regimen is used. In cases of sexual exposure, tests for gonorrhea and chlamydia should also be performed.

Imaging studies

Acutely, imaging studies are of little use, unless the presence of a foreign body or radiopaque material is suspected.