Overview of Agranulocytosis Stan Gerson, MD Chief, Division of Hematology & Oncology Asa & Patricia...
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Transcript of Overview of Agranulocytosis Stan Gerson, MD Chief, Division of Hematology & Oncology Asa & Patricia...
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/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
Clozaril® associated agranulocytosis
Serious disease in an affected individual
Represents a significant burden to health care
Early detection decreases risk
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
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
Advantages of monitoring system
Early detection prior to symptomsStop the drug earlyEarly initiation of treatment and management of agranulocytosisReassurance to patient, family and health care providers
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