A client with Crohn disease is starting azathioprine. Which … | MyMerci
Medical Emergencies PA
Question

A client with Crohn disease is starting azathioprine. Which baseline test is essential to determine starting dose and avoid severe myelosuppression?

Explanation
Correct (2): TPMT deficiency (homozygous low activity ~0.3% of population) leads to azathioprine accumulation and severe, potentially fatal myelosuppression. Genotype/phenotype guides dosing or avoidance. Also obtain baseline CBC, LFT, viral hepatitis serology. NUDT15 testing for Asian populations. (1,3,4) Unrelated to thiopurine safety.

In-depth explanation

Memory Tip Azathioprine/6-MP = "TPMT test before start." NUDT15 in Asian descent — additional pharmacogenomic check.

Clinical scenario

Scenario 42-year-old female with Crohn disease starting azathioprine. Pre-treatment workup.

Key concepts

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