**Question:** Before starting Infliximab in a 65-year-old gentleman for Inflammatory bowel disease, the following test is done:

A. Complete blood count (CBC)
B. Liver function tests (LFTs)
C. Kidney function tests (KFTs)
D. Coagulation profile

**Correct Answer:** .

**Core Concept:** Infliximab is a monoclonal antibody used for the treatment of various immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD). It is a biologic response modifier that targets tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine involved in the pathogenesis of IBD. Before initiating Infliximab therapy, it is essential to evaluate the patient's overall health, renal, hepatic, and coagulation status.

**Why the Correct Answer is Right:**

1. **Complete Blood Count (CBC):** Assessing the patient's leukocyte count, platelet count, and hemoglobin levels is crucial to identify any existing infections, bleeding disorders, or anemia, which could be exacerbated by Infliximab's immunosuppressive effects.
2. **Liver Function Tests (LFTs) and Kidney Function Tests (KFTs):** Evaluating liver and kidney function is essential as Infliximab can potentially cause adverse reactions in these organs, such as hepatitis and nephrotoxicity.
3. **Coagulation Profile:** Monitoring coagulation parameters is important to identify any preexisting bleeding tendencies or monitor the risk of bleeding complications during treatment. Infliximab can potentially increase the risk of bleeding due to its immunosuppressive effect on platelet function.

**Why Each Wrong Option is Incorrect:**

1. **Complete Blood Count (CBC):** While evaluating CBC is important, it is not as crucial as assessing liver and kidney function, which are directly affected by Infliximab therapy. CBC evaluation serves as a general health check but may not address the specific safety concerns associated with Infliximab.
2. **Liver Function Tests (LFTs) and Kidney Function Tests (KFTs):** Assessing these parameters is crucial, as Infliximab can potentially cause adverse reactions in the liver and kidneys. While evaluating LFTs and KFTs is essential, it is not as crucial as assessing coagulation parameters, which directly address the safety concerns associated with Infliximab therapy.
3. **Coagulation Profile:** Assessing coagulation parameters is crucial, as Infliximab can potentially increase the risk of bleeding due to its immunosuppressive effect on platelet function. Evaluating coagulation profile ensures that the patient is not at a higher risk of bleeding complications during therapy.

**Clinical Pearl:** Infliximab is a monoclonal antibody that targets TNF-alpha, a cytokine involved in the pathogenesis of IBD, and is used as an immunosuppressive agent. Before starting Infliximab, it is essential to screen for potential adverse reactions, such as hepatitis and nephrotoxicity, by assessing liver and kidney function (LFTs and KFTs). Monitoring coagulation parameters is