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.