Tests before Immunosuppression
Before starting systemic corticosteroids, it is important to confirm the diagnosis and also have leukaemia / malignancy considered and excluded - Full [complete] blood count and peripheral smear / blood film are indicated and where there is concern then a bone marrow.
Before starting immunosuppression (methotrexate or biologics), check the following:
- Full [complete] blood count.
- Acute phase reactants (CRP, ESR, +/- Ferritin).
- Liver function tests.
- Urea and Electrolytes / Creatinine.
- Infection screen to exclude:
- Tuberculosis; (Chest radiograph, Quanterferon Gold) - Mantoux if Quanteferon Gold not available.
- in endemic areas / at risk populations, Hepatitis B (unless child has received Hep B vaccine) Hep C and HIV status.
- Serology for Varicella and Measles status. If the child is negative and there is a window of time before starting immunosuppression then vaccination may be considered - specialist advice is warranted.