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British Medical Journal (Clinical... Jul 1982
Topics: Aged; Agranulocytosis; Dibenzazepines; Humans; Leukopenia; Male; Mianserin
PubMed: 6807414
DOI: No ID Found -
British Medical Journal (Clinical... Jun 1982
Topics: Aged; Agranulocytosis; Depressive Disorder; Dibenzazepines; Female; Humans; Mianserin
PubMed: 6805758
DOI: 10.1136/bmj.284.6333.1912-a -
Proceedings of the Royal Society of... Dec 1960
Topics: Agranulocytosis; Humans; Medical Records; Neutropenia
PubMed: 13687547
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... May 2020Neutropenia and agranulocytosis are among the most serious and feared adverse effects of antipsychotic drugs. In affected patients there is a risk of both infection and...
Neutropenia and agranulocytosis are among the most serious and feared adverse effects of antipsychotic drugs. In affected patients there is a risk of both infection and exacerbation of the underlying psychotic disorder, because neutropenia and agranulocytosis often require discontinuation of the antipsychotic drug therapy. The cause is most likely multifactorial. Whenever patients treated with antipsychotic drugs experience fever or other symptoms of infection, neutropenia should be considered as a differential diagnosis.
Topics: Antipsychotic Agents; Fever; Humans; Neutropenia; Psychotic Disorders
PubMed: 32463195
DOI: 10.4045/tidsskr.19.0713 -
WMJ : Official Publication of the State... Oct 2022Agranulocytosis, a severe decrease or absence of neutrophils, is a side effect of several medications, including chlorpromazine. If not promptly recognized, it can lead...
INTRODUCTION
Agranulocytosis, a severe decrease or absence of neutrophils, is a side effect of several medications, including chlorpromazine. If not promptly recognized, it can lead to overwhelming infection, sepsis, and death.
CASE PRESENTATION
A 72-year-old man with adenocarcinoma of the lung status-post recent lobectomy was admitted for postsurgical pain and electrolyte derangement. During his admission, he had intractable hiccups and was started on chlorpromazine 25 mg by mouth 3 times a day. Within a week, he developed pneumonia, type 1 respiratory failure, and a progressive neutropenia. Chlorpromazine-induced agranulocytosis was suspected and chlorpromazine was discontinued; however, the patient expired, with postmortem findings of aspergillus bronchopneumonia as cause of death.
DISCUSSION
Chlorpromazine is a well-studied cause of agranulocytosis. This case is novel in its rapid time course of less than 1 week; most cases report the resultant agranulocytosis on the order of weeks rather than days.
CONCLUSION
This case highlights an important need to recognize this medication side effect early so the offending agent may be stopped and the patient properly supported, so as to avoid the severe risk of neutropenic infection, sepsis, and death.
Topics: Male; Humans; Aged; Chlorpromazine; Hiccup; Agranulocytosis; Sepsis
PubMed: 36301662
DOI: No ID Found -
The New England Journal of Medicine Jul 1993Clozapine is an atypical antipsychotic agent that is more effective than standard neuroleptic drugs in the treatment of patients with refractory schizophrenia. Unlike...
BACKGROUND
Clozapine is an atypical antipsychotic agent that is more effective than standard neuroleptic drugs in the treatment of patients with refractory schizophrenia. Unlike classic neuroleptic agents, clozapine is not associated with the development of acute extrapyramidal symptoms or tardive dyskinesia. The main factor limiting its use is the risk of potentially fatal agranulocytosis, estimated to occur in 1 to 2 percent of treated patients. After clozapine was approved by the Food and Drug Administration, it became available for marketing in the United States in February 1990 only as part of a special surveillance system (the Clozaril Patient Management System, or CPMS), in which a weekly white-cell count was required for the patient to receive a supply of the drug.
METHODS
We evaluated the CPMS data for February 1990 through April 1991 by survival analysis to determine the incidence of agranulocytosis and the effects of potential risk factors such as age and sex. Data were available for 11,555 patients who received clozapine during the period after marketing began.
RESULTS
Agranulocytosis developed in 73 patients, resulting in death from infectious complications in 2 patients. Episodes of agranulocytosis occurred in 61 patients within three months after they began treatment. The cumulative incidence of this side effect was 0.80 percent (95 percent confidence interval, 0.61 to 0.99) at 1 year and 0.91 percent (95 percent confidence interval, 0.62 to 1.20) at 1 1/2 years. The risk of agranulocytosis increased with age and was higher among women.
CONCLUSIONS
The occurrence of agranulocytosis is a substantial hazard of the administration of clozapine, but this hazard can be reduced by monitoring the white-cell count. The increasing risk of agranulocytosis with age and the reduced incidence after the first six months of treatment provide additional guidelines for the prescription and monitoring of clozapine treatment in the future.
Topics: Adult; Agranulocytosis; Clozapine; Drug Monitoring; Female; Follow-Up Studies; Humans; Incidence; Leukocyte Count; Male; Middle Aged; Proportional Hazards Models; Risk Factors; United States
PubMed: 8515788
DOI: 10.1056/NEJM199307153290303 -
Scientific Reports Feb 2021Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPDs) are one of the most important clinical aspects of the disease, and when requiring hospital admission,...
Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPDs) are one of the most important clinical aspects of the disease, and when requiring hospital admission, they significantly contribute to mortality among COPD patients. Our aim was to assess the role of eosinopenia and neutrophil-to-lymphocyte count (NLR) as markers of in-hospital mortality and length of hospitalization (LoH) among patients with ECOPD requiring hospitalization. We included 275 patients. Eosinopenia was associated with in-hospital deaths only when coexisted with lymphocytopenia, with the specificity of 84.4% (95% CI 79.6-88.6%) and the sensitivity of 100% (95% CI 35.9-100%). Also, survivors presented longer LoH (P < 0.0001). NLR ≥ 13.2 predicted in-hospital death with the sensitivity of 100% (95% CI 35.9-100%) and specificity of 92.6% (95% CI 88.8-95.4%), however, comparison of LoH among survivors did not reach statistical significance (P = 0.05). Additionally, when we assessed the presence of coexistence of eosinopenia and lymphocytopenia first, and then apply NLR, sensitivity and specificity in prediction of in-hospital death was 100% (95% CI 35.9-100) and 93.7% (95% CI 90.1-96.3), respectively. Moreover, among survivors, the occurrence of such pattern was associated with significantly longer LoH: 11 (7-14) vs 7 (5-10) days (P = 0.01). The best profile of sensitivity and specificity in the prediction of in-hospital mortality in ECOPD can be obtained by combined analysis of coexistence of eosinopenia and lymphocytopenia with elevated NLR. The occurrence of a such pattern is also associated with significantly longer LoH among survivors.
Topics: Aged; Agranulocytosis; Disease Progression; Eosinophils; Female; Humans; Leukocyte Count; Lymphocyte Count; Lymphocytes; Male; Middle Aged; Neutrophils; Prognosis; Pulmonary Disease, Chronic Obstructive; Retrospective Studies
PubMed: 33637803
DOI: 10.1038/s41598-021-84439-8 -
Sao Paulo Medical Journal = Revista... May 2005
Topics: Agranulocytosis; Anti-Inflammatory Agents, Non-Steroidal; Dipyrone; Humans; Latin America; Multicenter Studies as Topic
PubMed: 16021269
DOI: 10.1590/s1516-31802005000300001 -
BMJ (Clinical Research Ed.) Jul 1988The relation of the use of antithyroid drugs to the risk of developing agranulocytosis and aplastic anaemia was evaluated in a population based case-control study with...
The relation of the use of antithyroid drugs to the risk of developing agranulocytosis and aplastic anaemia was evaluated in a population based case-control study with patients from Israel and seven regions in Europe. Data were obtained from cases and hospital controls by interview. Use of antithyroid drugs in the week before the onset of illness was compared in 262 patients with agranulocytosis and 1771 controls. Forty five patients (17%) and five controls (0.3%) had used antithyroid drugs. The relative risk was estimated to be 102 (95% confidence interval 38 to 275) taking into account confounding by other factors, including the use of other drugs. The excess risk for use of antithyroid drugs in any one week was estimated to be 6.3 cases of agranulocytosis per million users. Use of antithyroid drugs in a five month period ending one month before admission to hospital was compared in 135 patients with aplastic anaemia and 2145 controls. Four patients (3%) and five controls (0.2%) had taken drugs; the estimate of relative risk was 9.2 (95% confidence interval 1.8 to 47) after control for confounding. The estimate of excess risk of agranulocytosis with the use of antithyroid drugs was lower than found previously. Although the excess risk for aplastic anaemia was not calculated, these data suggest that it is very low.
Topics: Agranulocytosis; Anemia, Aplastic; Antithyroid Agents; Humans; Risk Factors
PubMed: 2458161
DOI: 10.1136/bmj.297.6643.262 -
Clinical Rheumatology Oct 2016Leukopenia is a considerably common complication of tocilizumab [TCZ] and rituximab [RTX] therapy. RTX-induced leukopenia typically exhibits delayed onset. While... (Review)
Review
Agranulocytosis under biotherapy in rheumatoid arthritis: three cases hypothesis of parvovirus B19 involvement in agranulocytosis observed under tocilizumab and rituximab for the treatment of rheumatoid arthritis.
Leukopenia is a considerably common complication of tocilizumab [TCZ] and rituximab [RTX] therapy. RTX-induced leukopenia typically exhibits delayed onset. While agranulocytosis has been reported linked to RTX treatment of lymphoma, this complication rarely occurs in rheumatoid arthritis (RA) treatment and, to our knowledge, has never been reported in association with TCZ therapy. We herein report four agranulocytosis cases in three patients, with the first two cases suspected to be secondary to human parvovirus B19 (PVB19) infection. Agranulocytosis manifested in the first patient 2 months following a third RTX course. Bone marrow (BM) polymerase chain reaction (PCR) was positive for PVB19. The patient relapsed after three TCZ courses, with her PCR again positive for PVB19. Both episodes resolved under granulocyte-macrophage colony-stimulating factor (GM-CSF). In the second patient, agranulocytosis manifested after the 74th TCZ course. Bone marrow PCR was positive for PVB19, and the evolution was favorable under intravenous immunoglobulin administration. The third case was a 53-year-old female patient with seropositive RA who presented agranulocytosis after the first infusion of her fourth RTX course. Unfortunately, no PCR PVB19 was made on myelogram. Evolution was favorable after 5 days of GM-CSF. PVB19 infection should be investigated in patients suffering from agranulocytosis manifesting during biotherapy. In cases manifesting from the 15th day of RTX treatment onwards, hemogram must be conducted before readministering the infusion.
Topics: Adult; Aged; Agranulocytosis; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Middle Aged; Parvovirus B19, Human; Rituximab; Treatment Outcome
PubMed: 27541023
DOI: 10.1007/s10067-016-3379-6