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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), it is important to 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 and QuantiFERON® Gold) - Mantoux would be the alternative where QuantiFERON® Gold is not available. 
  • in endemic areas / at risk populations; Hepatitis B and C and HIV status. Exceptions would be where the child has received Hep B vaccine. 
  • 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. 

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