What are the tests to be performed before initiating AZA therapy?

The patients should be screened for blood count, liver function, creatinine, and urine analysis (Chakravarty K et al. 2008). Low Hb% below 8 gms and lower platelet count are relative contraindications to start the drug. Since AZA is eliminated by hepatic metabolism and renal excretion increases the risk of adverse events, due caution should be taken while introducing the drug. Screening for hepatitis B and C is mandatory and AZA should be avoided in such cases (Villalba SR et al. 2011). The use of TPMT assay to diagnose delayed hematotoxicity, including bone marrow toxicity, is debatable (Konstantopoulou M et al. 2005). Owing to the increased risk for immune suppression, the chances of any occult infection including tuberculosis should be
excluded through clinical examination. Work-up for occult tuberculosis is not recommended.

REFERENCE
1. Chakravarty K, McDonald H, Pullar T, Taggart A, Chalmers R, Oliver S, Mooney J,Somerville M, Bosworth A, Kennedy T; British Society for Rheumatology, British Health Professionals in Rheumatology Standards, Guidelines and Audit Working Group; British Association of Dermatologists (BAD). BSR/BHPR
guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Associationon of Dermatologists. Rheumatology
(Oxford). 2008;47(6):924-5.
2. Cabrera Villalba SR, Victoria HernaSRm Miguel M, Sanmartr Sala R. How does one manage patients with rheumatoid arthritis and positive serology to
hepatitis B, hepatitis C, human immunodeficiency virus. ReumatolClin. 2011;7(3):203-7.
3. Konstantopoulou M, Belgi A, Griffiths KD, Seale JR, Macfarlane AW. Azathioprine induced pancytopenia in a patient with pompholyx and deficiency of erythrocyte thiopurine methyltransferase. Br Med J 2005;330:350-1.

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