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One in 300 individuals lack enzyme activity and 11% are heterozygous for a variant low activity allele and have an intermediate activity. The thiopurine drugs azathioprine, mercaptopurine and thioguanine are substrates for\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    ; these drugs exhibit well documented myelosuppressive effects on haematopoietic cells and have a track record of idiosyncratic drug reactions. The development of severe bone marrow toxicity, in patients taking standard doses of thiopurine drugs, is associated with\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    deficiency whilst the\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    heterozygote is at an increased risk of developing myelosuppression. Factors influencing\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    enzyme activity, as measured in the surrogate red blood cell, are discussed in this review to enable an appreciation of why concordance between\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    genotype and phenotype is not 100%. This is particularly important for lower\/intermediate\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    activities to avoid misclassification of\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    status.\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    testing is now widely available in routine service laboratories. The\n                    <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>\n                    ritish\n                    <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>\n                    ational\n                    <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>\n                    ormulary suggests\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    testing before starting thiopurine drugs. Dermatologists were quick to adopt routine\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    testing whilst gastroenterologists do not specifically recommend\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    screening.\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    testing is mandatory prior to the use of mercaptopurine in childhood leukaemia. Thiopurine drug dose and other treatment related influences on cell counts explain some of the differing recommendations between clinical specialities.\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    testing is cost\u2010effective and the major role is in the identification of the\n                    <jats:styled-content style=\"fixed-case\">TPMT<\/jats:styled-content>\n                    deficient individual prior to the start of thiopurine drugs.\n                  <\/jats:p>","DOI":"10.1111\/bcp.12226","type":"journal-article","created":{"date-parts":[[2013,8,21]],"date-time":"2013-08-21T05:50:45Z","timestamp":1377064245000},"page":"704-714","source":"Crossref","is-referenced-by-count":122,"title":["Implementation of\n                    <scp>TPMT<\/scp>\n                    testing"],"prefix":"10.1111","volume":"77","author":[{"given":"Lynne","family":"Lennard","sequence":"first","affiliation":[{"name":"Clinical 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