Abstract
Background. A 50-year-old man who had received a simultaneous pancreas and kidney transplant 9 years earlier developed pancytopenia 3 weeks after starting azathioprine therapy to treat worsening proteinuria suspected to be caused by sirolimus.
Investigations. Laboratory tests, including complete blood counts, measurement of serum levels of vitamin B12 and folate, liver function tests, virological assays, and thiopurine S-methyltransferase (TPMT) genotyping.
Diagnosis. Severe myelosuppression as a consequence of azathioprine therapy in a patient homozygous for the TPMT*3A allele.
Management. Discontinuation of azathioprine, treatment with an erythropoiesis-stimulating agent, red blood cell transfusions, filgrastim (a granulocyte colony-stimulating factor analogue) and folic acid.
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P. Budhiraja and M. Popovtzer contributed equally to researching data for this article, discussion of content, writing, and reviewing and editing of the manuscript before submission.
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Budhiraja, P., Popovtzer, M. Azathioprine-related myelosuppression in a patient homozygous for TPMT*3A. Nat Rev Nephrol 7, 478–484 (2011). https://doi.org/10.1038/nrneph.2011.74
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DOI: https://doi.org/10.1038/nrneph.2011.74
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