A 58-year-old man is about to start rituximab for diffuse large B cell lymphoma. Which screening test is mandatory before the first infusion because of a potentially fatal complication of therapy?
- A Hepatitis B surface antigen and anti-HBc antibody ✓
- B Quantiferon TB gold assay
- C Serum free light chains
- D JC virus PCR in plasma
Correct answer: A. Hepatitis B surface antigen and anti-HBc antibody
Explanation
Rituximab depletes CD20-positive B cells and is a well recognised cause of hepatitis B virus reactivation, which can progress to fulminant hepatic failure. Guidelines require HBsAg and anti-HBc testing before starting, with prophylactic antiviral therapy if positive. The best distractor is TB screening, relevant to anti-TNF agents rather than B cell depletion. JC virus testing relates to natalizumab-associated progressive multifocal leukoencephalopathy.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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