Lymphocytopenia in patients with inflammatory bowel disease on immunosuppressive medications

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Title: Lymphocytopenia in patients with inflammatory bowel disease on immunosuppressive medications
Author: Bincy Paulose Abraham
Abstract: Azathioprine and 6 -mercaptopurine (AZA /6MP ) are effective immunosuppressives commonly used for the treatment of inflammatory bowel disease (IBD ) . The mercaptopurine metabolites , 6 -thioguanine (6TG ) and 6 -methylmercaptopurine ribonucleotides (6MMP ) , have been suggested as surrogate markers of the safety and efficacy of immunosuppressive therapy . Elevated levels of 6TG have been found to be associated with bone marrow toxicity manifest as leukopenia . Elevated 6 -MMP levels have been associated with hepatotoxicity . This study aims to evaluate the incidence of lymphocytopenia with immunosuppressive use , to correlate metabolite levels (6TG and 6MMP ) with leukocyte (WBC ) , lymphocyte , mean corpuscle volume (MCV ) levels in IBD patients treated with AZA /6MP , and secondarily to evaluate clinical status with these blood markers . \r \nMedical records of adult IBD patients taking either azathioprine or 6 -mercaptopurine were analyzed based on blood counts , mercaptopurine metabolites 6TG and 6MMP , and clinical status . Eighty three percent of the patients taking AZA /6MP developed lymphocytopenia . Of those with lymphocytopenia , only 12 % had low WBC counts . A low correlation of r = -0 .3 (p=0 .04 ) for 6TG to WBC counts as well as to MCV levels was found . No correlation between 6TG levels and lymphocyte counts were noted . Clinical activity to any blood markers showed no significant correlation . \r \nThis analysis shows that lymphocyte counts and not leukocyte counts should be monitored closely in patients on these immunosuppressives , and that metabolite markers do not provide information regarding who will develop lymphocytopenia . Blood markers cannot be used as a marker for disease activity although further detailed studies will need to be done . Consequences of lymphocytopenia such as opportunistic infections need to be discussed with patients prior to starting this type of therapy . \r \n
URI: http : / /hdl .handle .net /2152 .3 /273
Date: 2007-11-16

Citation

Lymphocytopenia in patients with inflammatory bowel disease on immunosuppressive medications. The University of Texas Medical Branch. Available electronically from http : / /hdl .handle .net /2152 .3 /273 .

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