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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), 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, QuantiFERON® Gold) - Mantoux if QuantiFERON® 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. 

 

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