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Can Azathioprine Cause Leukocytosis?

Posted on Wed, 7 Oct 2015

Question: Hi my daughter (11) was diagnosed in the spring with Crohn's. She is mildly anemic (112 Hb, Hct 0.34 (sept 10, (0.34) and has low ALP and ALT levels. She is taking Azathioprine (25mg one day, 50 mg) (50mg starting beginning of july, dose altered in sept due to high TPMT metabolites (865) the next, and is heterozygous for TMPT. She has just started to take 1500 mg of Pensa (mesalamine). She is experiencing some fatigue. She also has mild leukocytosis (WBC 11). Would the leukocytosis be due to the drugs? Would it be reasonable for me to add iron to her diet?

Answered by Dr. Pradeep Kumar Jain (50 minutes later)

Brief Answer:
Azathioprine causes leukopenia

Detailed Answer:
Hello

Thanks for asking on this platform

I can understand your concern. Azathioprine causes leukopenia(low WBC count)not leukocytosis.
Dose adjustment is needed in case of high TPMT metabolites as done in your case.Regular monitoring of TMPT is needed to adjust the dose of azathioprine to avoid bone marrow suppression(leukopenia,thrombocytopenia and anemia).
The most common cause of anemia is iron deficiency.
But before adding Iron to diet I would like to get Iron profile done.

Wishing for your baby's good health.
Please let me know if you have any more doubt.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (8 minutes later)

Would Iron profile (Aug 5 had iron 3, iron sat 0.05, transferrin 2.72, ferritin 21) tell underlying cause of anemia?

Answered by Dr. Pradeep Kumar Jain (32 minutes later)

Brief Answer:
The iron profile is disproportionate to anemia

Detailed Answer:
Thanks for follow up

The values of iron profile which you have mentioned are very low(Except the ferritin level).But the hemoglobin level is not proportionate to the iron deficiency(for such values there should be very low hemoglobin).
In anemia of chronic disease(Crohn's disease is one of them) can present with this picture.
Iron supplementation helps in anemia of chronic disease.
I would request you to attach the report so that I better able to assess the report and to help out.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar