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Overview of Agranulocytosis

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. Agranulocytosis. Drop in neutrophil count to less than 500/mm 3

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Overview of Agranulocytosis

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  1. 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

  2. Agranulocytosis • Drop in neutrophil count to less than 500/mm3 • High incidence of neutropenic fever [>80%] • Duration of agranulocytosis directly impacts its severity and morbidity [fever in 100% of patients after 5 days] • Mortality is related to infections and their sequella • Rare in the absence of a serious illness or drug administration

  3. Clozaril® associated agranulocytosis • Serious disease in an affected individual • Represents a significant burden to health care • Early detection decreases risk

  4. Key features of clozapine associated agranulocytosis • 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 • Often the drug is stopped with a WBC of 2000-3000 and an ANC of 300-1000 • 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

  5. Management of agranulocytosis • Hospitalization of patient is recommended • Daily observation for fever, infection; culture and image of possible sites of infection • Antibiotics - either prophylactic or for fever • Hematopoietic growth factors [G-CSF, GM-CSF] • Duration of illness - 8-25 days • Substantial cost for treatment: hospitalization, antibiotics and growth factors

  6. Advantages of monitoring system • Early detection prior to symptoms • Stop the drug early • Early initiation of treatment and management of agranulocytosis • Reassurance to patient, family and health care providers

  7. Conclusions • Clozaril associated agranulocytosis is a serious illness • Monitoring allows detection prior to illness • Early detection can limit morbidity by prompt institution of management • Management is costly

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