A 68-year-old male with lab values WBC = 10, ALT = 348, AST = 148 states he feels well. What should be done next?

In the scenario presented, the patient has elevated liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST), while also maintaining a white blood cell count (WBC) within a normal range. These particular enzyme elevations raise the suspicion for liver-related conditions, such as hepatitis, fatty liver disease, or other forms of liver injury.

Ordering a hepatitis panel is an appropriate next step because it will help identify if there is an underlying viral hepatitis that could be responsible for the significant elevations in ALT and AST. Hepatitis viruses such as A, B, C, and others could present with similar laboratory findings, and since the patient is 68 years old, he may be at increased risk for viral hepatitis infections.

By determining the specific cause of the liver enzyme elevation early, appropriate management can be initiated, which may involve further treatment or monitoring based on the hepatitis type and other liver-related issues. Thus, ordering a hepatitis panel provides actionable information that is critical for diagnosis and treatment planning in this case.