Nonchemotherapy drug-induced agranulocytosis: experience of the Strasbourg teaching hospital (1985-2000) and review of the literature.
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.
Andrès
E
E
Department of Internal Medicine, Hôpitaux Universitaires of Strasbourg, France. Emmanuel.Andres@chru-strasbourg.fr
Kurtz
J-E
JE
Maloisel
F
F
D000368:Aged; D000380:Agranulocytosis / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D005602:France / Q000453:epidemiology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007239:Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D013956:Antithyroid Agents; D010975:Platelet Aggregation Inhibitors; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor