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Overview of Agranulocytosis Stan Gerson, MD Chief, Division of Hematology & Oncology Asa & Patricia Shiverick Professor of Hematological Oncology University Hospitals of Cleveland, Case Western Reserve University
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Agranulocytosis l Drop in neutrophil count to less than 500/mm 3 l High incidence of neutropenic fever [>80%] l Duration of agranulocytosis directly impacts its severity and morbidity [fever in 100% of patients after 5 days] l Mortality is related to infections and their sequella l Rare in the absence of a serious illness or drug administration
![Agranulocytosis l Drop in neutrophil count to less than 500/mm 3 l High incidence of neutropenic fever [>80%] l Duration of agranulocytosis directly impacts its severity and morbidity [fever in 100% of patients after 5 days] l Mortality is related to infections and their sequella l Rare in the absence of a serious illness or drug administration](http://images.slideplayer.com/26/8402604/slides/slide_2.jpg "Agranulocytosis l Drop in neutrophil count to less than 500/mm 3 l High incidence of neutropenic fever [>80%] l Duration of agranulocytosis directly impacts its severity and morbidity [fever in 100% of patients after 5 days] l Mortality is related to infections and their sequella l Rare in the absence of a serious illness or drug administration")
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Clozaril ® associated agranulocytosis l Serious disease in an affected individual l Represents a significant burden to health care l Early detection decreases risk
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Key features of clozapine associated agranulocytosis l Onset in 1-3 weeks - detected by monitoring Rapid onset is more severe Benefit from early detection, drug is stopped prior to onset of symptoms l Often the drug is stopped with a WBC of 2000-3000 and an ANC of 300-1000 l Unique features Severe drop in granulocyte count [to 0] even after the drug is stopped Prolonged duration [8d with growth factors, 15 d without] Significant risk of neutropenic fever, severe internal infection
![Key features of clozapine associated agranulocytosis l Onset in 1-3 weeks - detected by monitoring Rapid onset is more severe Benefit from early detection, drug is stopped prior to onset of symptoms l Often the drug is stopped with a WBC of and an ANC of l Unique features Severe drop in granulocyte count [to 0] even after the drug is stopped Prolonged duration [8d with growth factors, 15 d without] Significant risk of neutropenic fever, severe internal infection](http://images.slideplayer.com/26/8402604/slides/slide_6.jpg "Key features of clozapine associated agranulocytosis l Onset in 1-3 weeks - detected by monitoring Rapid onset is more severe Benefit from early detection, drug is stopped prior to onset of symptoms l Often the drug is stopped with a WBC of and an ANC of l Unique features Severe drop in granulocyte count [to 0] even after the drug is stopped Prolonged duration [8d with growth factors, 15 d without] Significant risk of neutropenic fever, severe internal infection")
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Management of agranulocytosis l Hospitalization of patient is recommended l Daily observation for fever, infection; culture and image of possible sites of infection l Antibiotics - either prophylactic or for fever l Hematopoietic growth factors [G-CSF, GM- CSF] l Duration of illness - 8-25 days l Substantial cost for treatment: hospitalization, antibiotics and growth factors
![Management of agranulocytosis l Hospitalization of patient is recommended l Daily observation for fever, infection; culture and image of possible sites of infection l Antibiotics - either prophylactic or for fever l Hematopoietic growth factors [G-CSF, GM- CSF] l Duration of illness days l Substantial cost for treatment: hospitalization, antibiotics and growth factors](http://images.slideplayer.com/26/8402604/slides/slide_8.jpg "Management of agranulocytosis l Hospitalization of patient is recommended l Daily observation for fever, infection; culture and image of possible sites of infection l Antibiotics - either prophylactic or for fever l Hematopoietic growth factors [G-CSF, GM- CSF] l Duration of illness days l Substantial cost for treatment: hospitalization, antibiotics and growth factors")
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Advantages of monitoring system l Early detection prior to symptoms l Stop the drug early l Early initiation of treatment and management of agranulocytosis l Reassurance to patient, family and health care providers
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Conclusions l Clozaril associated agranulocytosis is a serious illness l Monitoring allows detection prior to illness l Early detection can limit morbidity by prompt institution of management l Management is costly
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