Nonchemotherapy drug-induced agranulocytosis: experience of the Strasbourg teaching hospital (1985-2000) and review of the literature

Abstract

Agranulocytosis is a life-threatening disorder that frequently occurs as an adverse reaction to drugs. The overall incidence of nonchemotherapy drug-induced agranulocytosis (DIA) ranges from 2.6 to 10 cases per million patients exposed to drugs per year. Although patients experiencing DIA may initially be asymptomatic, the severity of the neutropenia usually leads to severe sepsis, requiring intravenous broad-spectrum antibiotic therapy. In this setting, old age, septicaemia, shock, and the metabolic complications of infection, such as renal failure, are poor prognostic variables. The severity of neutropenia (< 0.1 x 10(9))/l) and its duration (> 10 days) may also impact negatively on the outcome. With appropriate management using pre-established procedures, the mortality rate is now around 5%. Haematopoietic growth factors have been shown to shorten the duration of neutropenia in DIA. However, it has yet to be determined whether their use translates into a better outcome in DIA patients experiencing sepsis. DIA still remains a rare event. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.

Toxic epidermal necrolysis and agranulocytosis: Rare adverse effects of ciprofloxacin

“…[3] The overall incidence of non chemotherapy drug induced agranulocytosis ranges from 2.6 to 10 cases per million patients exposed to drugs per year. [7] Neutropenia usually leads to severe sepsis, requiring IV broad spectrum antibiotic therapy, as in our patient. The severity of neutropenia and its duration may also impact negatively on the outcome.…”

Pancytopenýa and Sepsýs due to Meropenem: A Case Report

“…The overall incidence of non-chemotherapy drug-induced agranulocytosis ranges from 2.6 to 10 cases per million patients exposed to the drugs per year [4]. Neutropenia usually leads to severe sepsis, requiring iv broad-spectrum antibiotic therapy, as in the case of our patient.…”

“…Hemopoietic growth factors have been shown to shorten the duration of neutropenia in drug-induced agranulocytosis. With appropriate management, the mortality rate is around 5 % [4].…”

Agranulocytoses médicamenteuses idiosyncrasiques

“…D'après les travaux réalisés jusqu'à présent (surtout in vitro), les AMI seraient la conséquence de 2 mécanismes principaux : immuno-allergiques et/ou toxiques [21,26]. Les AMI d'origine immuno-allergique seraient secondaires à la présence d'anticorps dirigés contre les polynucléaires neutrophiles ou leurs précurseurs myéloïdes [27,28].…”