Incidence, etiology and bone marrow characteristics of non‐chemotherapy‐induced agranulocytosis

Abstract

Antimicrobial agents are the most common cause and the rare granulocyte precursors in bone marrow are associated with higher mortality rates.

Sudden Onset Agranulocytosis and Hepatotoxicity after Taking Methimazole

“…In addition, bone marrow examination is useful in revealing the characteristics of direct toxic effects in agranulocytosis. Hypoplasia with decreased or absent precursor cells is a common characteristic of drug toxic effects of bone marrow (15,16). In the present patient, the bone marrow showed hyperplasia with normal erythroid and lymphoid progenitor cells, only granulocyte precursors were signifi- WBC: white blood cell, ALT: alanine aminotransferase, AST: aspartate aminotransfe rase, G-CSF: Granulocyte-colony stimulating factor, Tmax: maximal body temperature, "-7" refers to the seventh day before hospitalization; "-" means no such examinations done or drugs administration.…”

Intravenous Cloxacillin Induced Agranulocytosis in a Haemodialysis Patient

“…A few antibiotics were known to cause agranulocytosis, such as trimethoprim-sulfamethoxazole, ceftazidime, cloxacillin, clindamycin, gentamycin, and chloramphenicol [1]. Although our patient was given both the IV ceftriazone and IV cloxacillin, it is unlikely that the cause is due to ceftriazone as it was stopped within a few days of its initiation.…”

Amitriptyline-Induced Agranulocytosis With Bone Marrow Confirmation

“…Type 1 is thought to be a result of immune complexes selectively attaching to granulocytes and their precursors, resulting in intravascular complement-mediated granulocyte destruction (peripheral destruction). 8,9 Type 2 is speculated to be a result of direct toxic suppression of granulopoietic precursors, leading to underproduction, but it affects only granulocytes, leaving other cell types unaffected. 8 The suspected diagnosis of drug-induced agranulocytosis requires a careful review of the patient's medication history.…”

“…8,9 Type 2 is speculated to be a result of direct toxic suppression of granulopoietic precursors, leading to underproduction, but it affects only granulocytes, leaving other cell types unaffected. 8 The suspected diagnosis of drug-induced agranulocytosis requires a careful review of the patient's medication history. The patient in this case presented after CYBORD chemotherapy for MM.…”

“…In one pattern (type 1), the bone marrow is usually hypercellular with adequate neutrophil precursors, Amitriptyline-Induced Agranulocytosis but there is an arrested neutrophil maturation, with few or no mature forms of neutrophils beyond myelocytes. 8,9 In the second pattern (type 2), there is a severe reduction or complete absence of granulocytic precursors with normal or increased erythropoiesis and megakaryocytes. The latter was seen in the present patient and is reportedly associated with higher mortality 8 and a longer duration of fever and time to neutrophil recovery.…”