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Testing for variants in the genes that encode TPMT and nudix hydrolase 15 (NUDT15), another enzyme involved in thiopurine metabolism, may be useful to identify patients at risk of myelotoxicity and intolerance

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Excellent dietary sources include: Liver and organ meats : Beef liver provides approximately 70 mcg per 100gfar exceeding daily needs Shellfish : Clams, mussels, and crab are exceptionally rich sources Fish : Salmon (5 mcg per 100g), trout, tuna, and mackerel provide substantial amounts Meat and poultry : Beef, lamb, and chicken contain 13 mcg per 100g Dairy products : Milk (0.4 mcg per 100ml), cheese, and yoghurt contribute meaningfully Eggs : One large egg provides approximately 0.6 mcg For vegans and vegetarians , reliable B12 sources are essential as plant foods contain no bioavailable B12 (despite some claims about algae or fermented products)