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 Quanterferon Gold) - Mantoux would be the alternative where Quanteferon 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.