A patient on methotrexate has stable disease but serial monitoring shows a progressive fall in platelets from 238 to 171 to 98 ×10⁹/L. Haemoglobin

Question

A patient on methotrexate has stable disease but serial monitoring shows a progressive fall in platelets from 238 to 171 to 98 ×10⁹/L. Haemoglobin and neutrophils are stable and there is no bleeding. What is the best next step under current BSR monitoring principles?

Accepted Answer

Withhold methotrexate, contact rheumatology and investigate the platelet trend

Answer

Reduce methotrexate only if mean platelet volume is also outside range

Answer

Permanently withdraw methotrexate without repeating the count or reviewing other drugs

Answer

Continue unchanged until the platelet count is below 50 ×10⁹/L

Answer

Repeat the full blood count at the routine annual review because isolated thrombocytopenia is not actionable

MTX Hair Thinning — SCE Rheumatology MCQ

A patient on methotrexate has stable disease but serial monitoring shows a progressive fall in platelets from 238 to 171 to 98 ×10⁹/L. Haemoglobin and neutrophils are stable and there is no bleeding. What is the best next step under current BSR monitoring principles?