title: Azathioprine-related myelosuppression in a patient homozygous for TPMT*3A.
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.
  
  
  METHODS
  Laboratory tests, including complete blood counts, measurement of serum levels of vitamin B(12) and folate, liver function tests, virological assays, and thiopurine S-methyltransferase (TPMT) genotyping.
  
  
  METHODS
  Severe myelosuppression as a consequence of azathioprine therapy in a patient homozygous for the TPMT*3A allele.
  
  
  RESULTS
  Discontinuation of azathioprine, treatment with an erythropoiesis-stimulating agent, red blood cell transfusions, filgrastim (a granulocyte colony-stimulating factor analogue) and folic acid.
authors.affiliation: Southern Arizona Veterans Affairs Health Care System, 3601 South 6th Avenue, Tucson, AZ 85723, USA. budhirajap@yahoo.com
authors.forename: Pooja
authors.initials: P
authors.lastname: Budhiraja
authors.forename: Mordecai
authors.initials: M
authors.lastname: Popovtzer
mesh_terms: D001379:Azathioprine / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D000069585:Filgrastim; D005492:Folic Acid / Q000627:therapeutic use; D005838:Genotype; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006720:Homozygote; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008111:Liver Function Tests; D008297:Male; D008780:Methyltransferases / Q000235:genetics*; D008875:Middle Aged; D016035:Pancreas Transplantation; D010198:Pancytopenia / Q000139:chemically induced* / Q000628:therapy; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D005492:Folic Acid; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D001379:Azathioprine; D000069585:Filgrastim