Diagnosis and Management of Idiopathic Drug-Induced Severe Neutropenia and Agranulocytosis

Abstract

In this paper, we report and discuss the diagnosis and management of severe neutropenia and agranulocytosis (neutrophil count of < 0.5 x 109/L) related to drug intake, thus considered as “idiopathic” in case of unpredictable. For practitioners and pharmacists, it is important to keep in mind that almost all classes of drugs have been implicated (“causative”), but for the majority the risk appears to be very small. This rare event (2.4 to 15.4 per million per year), remains a potentially serious adverse event of drugs due to the presence of severe deep tissue infections (e.g., pneumonia), septicaemia, and septic shock in approximately two-thirds of the patients. Recently, several prognostic factors have been identified that may be helpful when identifying frailty patients. Old age (> 65 years), septicaemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1×109/L have been consensually accepted as poor prognostic factors for haematological recovery. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and haematopoietic growth factors (particularly G-CSF), is likely to improve the prognosis. Thus, with appropriate management, the mortality rate of idiosyncratic drug-induced agranulocytosis is currently around 5%. Key words: Agranulocytosis; Neutropenia; Drugs; Infections; Antibiotics; Haematopoietic Growth Factor;