Overview of Agranulocytosis

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 gt80
• 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
(No Transcript)
4
Clozaril associated agranulocytosis

• Serious disease in an affected individual
• Represents a significant burden to health care
• Early detection decreases risk

5
(No Transcript)
6
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

7
(No Transcript)
8
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

9
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

10
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