5.1.3 Haematological assessment

Due to the risk of myelosuppression associated with even relatively short exposures to linezolid, pretreatment assessment of haemoglobin, neutrophils and platelets is crucial in patients considering treatment with a linezolid-containing regimen. Severe anaemia in patients with TB is a significant risk factor for poor treatment outcomes (48), and patients with a low baseline haemoglobin may be at risk of severe linezolid-induced haematological toxicity. The linezolid-containing 9-month regimen must not be offered to patients with a pretreatment serum haemoglobin below 8 g/dL that cannot be rapidly corrected (i.e. with a blood transfusion) before starting MDR/RR-TB treatment. Similarly, due to the morbidity associated with severe neutropenia and thrombocytopenia, the linezolid-containing 9-month regimen is not suitable in patients with neutrophils below 0.75 × 109/L or platelets below 150 × 109/L before starting treatment.

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