Discussion on Agranulocytosis

Abstract

Professor L. J. Witts: There are still manv gaps in our knowledge of agranulocytosis, such as its incidence in this country, its mortality, the role of amidopyrine in the wtiology, and the efficacy of treatment. The following seven cases are discussed more especially as they bear on these points.I.-Chronic leucol)enia folloving occasional use of amido)loyrIne: Recove,ry.Mrs. H. J. S., aged 54, complained of excessive weakness and recurrent stomatitis. She had taken amidopyrine and novalgin, a drug which contains amidopyrine, for rheumatism at intervals for some years before these symptoms began. She was never acutely ill and her lowest white count was 2,400 per c.mm., with 1,152 granulocytes. Pentnucleotide was not well tolerated but she obtained apparent benefit from a liver diet. It is interesting to note that her son, aged 24, who was subject to fibrositis and had at times taken amidopyrine, had occasionally presented a leueopenia. In 1931 his total white cell count was 4,800 per c.mm. with 1,488 granulocytes, and in 1935 his total white cell count was 4,600 per c.mm., with 2,218 granulocytes.I.-Chronic leucolenia, afte-long-contitnned use of salol: Slpontaneous 'imnrovement. Mr. F., aged 60, complained of exhaustion. His total white count was 1,600 per c.mm., with 912 granulocytes. He denied having taken amidopyrine but had taken salol for nmany years for recurrent colitis. After a holiday, with high vitamin diet and avoidance of salol, his total white cell count rose to 3,800 per c.inm. Two years later he was found to be suffering from chronic alcoholism with mental deterioration and, looking back, I do not thinkl much weight can be attached to the denial of having takent amidopyrine.III.-Agranalocytic angina after the usc of ainidopyrine an(l eviJ)an: Recorery following trca tinel lit wv itlh neo-arsphenamine, pentntcleotide, and transt'usio n.Mrs. H., aged 24, developed an apical abscess in a tooth that had been filled some years before. She had about twelve doses of various amidopyrine-containing compounds before the blood was examined and agranulocytosis was discovered. Veramon was taken for the toothache, one tablet daily, then one allonal tablet, and finally more veramon after an extraction under evipan. On the fifth day after the extraction she was profoundly ill, with high fever, ulceration of the fauces, the cheeks and the gulmls, and Ludwig's angina. Vincent's organisms were present in the mouth and 0-1 grin. neo-arsphenamine was injected intravenously. A blood-count taken at the same time showed a total of 2,000 white cells per c.mm., with only 100 granulocytes; there was a moderate secondary anemia, such as might have been expected as a result of the dental extraction and septic infection. She was treated with transfusions and full doses of pentnucleotide and ultimately made a complete recovery. The blood, examined on several occasions during the subsequent two years, has always been within normal litnits.