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Methotrexate Monitoring — UKMLA MCQ

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HardRheumatologyMethotrexate MonitoringUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A patient taking stable weekly methotrexate has routine monitoring. Which isolated result most clearly requires withholding methotrexate and contacting the specialist team?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — White cell count 2.5 ×10⁹/L, well below the withholding threshold

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

C is correct. A white cell count of 2.5 ×10⁹/L is substantially below the commonly used methotrexate withholding threshold of 3.5 ×10⁹/L and suggests potentially serious marrow suppression. Methotrexate should be withheld and the specialist team contacted, with urgent clinical assessment if fever, sore throat, mouth ulcers, bruising or bleeding are present. The other values are either stable, within usual limits or below an absolute liver threshold without an adverse trend, although all results must still be interpreted using local shared-care guidance. Progressive change can be important even before an absolute threshold is crossed.

Reference: NHS Specialist Pharmacy Service, methotrexate monitoring: https://www.sps.nhs.uk/monitorings/methotrexate-monitoring/