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.