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Surely, the point is that the dermatologists start at a low dose and monitor the clinical effect and we monitor to ensure that no ill effects occur: With FBC monitoring I have yet to have received a complaint about a clinical problem due to our failure to provide the TPMT test because doses are always stepped up slowly. TIM *************************************************************************************** Prof. T. Reynolds, Clinical Chemistry Dept, Queens Hospital, Belvedere Rd., Burton-on-Trent, STAFFS, DE13 0RB. --------- Tel: +44 (0)1283 511511 ext. 4035 Fax: +44 (0)1283 593064 ----------- [log in to unmask] -----Original Message----- From: c=GB;a=NHS;p=NHS NATIONAL INT;dda:RFC-822=acb-clin-chem-gen-request(a)mailbase.ac.uk; Sent: Friday, February 04, 2000 11:08 PM To: c=GB;a=NHS;p=NHS NATIONAL INT;dda:RFC-822=acb-clin-chem-gen(a)mailbase.ac.uk; Subject: RE: Azathioprine treatment and assaying thiopurine methyltransferase yu activity >We Had a similar query from a dermatologist: we told him to monitor FBC as this was more readily available >than assaying the drug itsef, monitored the drugs effect AND was significantly cheaper! This is missing the point! The advantage of TPMT measurement is that you can detect susceptibility to azathioprine *before* you give it, and adjust the dose accordingly, rather than monitoring FBC afterwards to see how much damage you've done... Mike Hallworth %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%