# A client with Crohn disease is scheduled to start infliximab. Which test must be completed before the first infusion?

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> subject: Crisis Intervention  
> category: PSI

## Question

A client with Crohn disease is scheduled to start infliximab. Which test must be completed before the first infusion?

## Option

1. Latent TB screening (TST or IGRA) plus HBV serology, because TNF-alpha inhibitors can reactivate latent TB and hepatitis B **✔ Correct answer**
2. Echocardiogram
3. Bone density scan
4. CT chest

**Correct answer: 1**

## Explanation

Correct (2): Anti-TNF biologics (infliximab, adalimumab, etanercept, certolizumab, golimumab) carry a boxed warning for serious infections including reactivation of latent TB and hepatitis B. Screen with TST/IGRA + HBV serology before first dose. Treat latent TB before initiation. (1,3,4) Unrelated to standard pre-biologic workup.

## In-depth explanation

Memory Tip Anti-TNF = "Tube-Necrosis-Factor blocker" before starting: TB + Hep B + JC virus precautions. Infusion reactions also monitored.

## Clinical scenario

Scenario 35-year-old male with refractory Crohn disease scheduled for infliximab 5 mg/kg IV. Pre-infusion checklist.

## Key concepts

- **TNF-alpha inhibitor** — Biologic class — infliximab, adalimumab, etanercept; boxed warning for infections.
- **Latent TB screening** — TST (≥5 mm positive) or IGRA before starting anti-TNF therapy.
- **Infliximab infusion reaction** — Acute (during/within 24h) or delayed (1-14 days); slow infusion with premedication if reactive.

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