skip to main content

Thiopurine Metabolite-Guided Dose Adjustment — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardRenal VasculitisThiopurine Metabolite-Guided Dose AdjustmentESENeph

A patient receiving azathioprine maintenance after ANCA-associated vasculitis induction has WCC 3.3 ×10⁹/L and neutrophils 1.7 ×10⁹/L, falling steadily from normal. There is no intercurrent infection. Which action matches NHS SPS monitoring advice?

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

Reveal the answer and explanation

Correct answer: A — Withhold azathioprine, contact the specialist and repeat the blood count

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

A is correct. SPS advises considering stopping azathioprine and contacting the specialist when WCC is below 3.5 ×10⁹/L or neutrophils below 1.6 ×10⁹/L. It also emphasises trends, so a steady fall deserves action even when one component remains just above its absolute threshold. Normal pre-treatment TPMT does not exclude later marrow toxicity. The immediate task is interruption, assessment for infection and interacting medicines, and prompt repeat testing; the eventual maintenance alternative depends on count recovery, vasculitis history and toxicity assessment rather than an automatic return to cyclophosphamide.

Reference: NHS SPS: azathioprine monitoring: https://sps.nhs.uk/monitorings/azathioprine-monitoring/