Recognition and management of drug-induced blood cytopenias: the example of drug-induced acute neutropenia and agranulocytosis.
BACKGROUND
More than several hundred drugs, toxins, and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias.


OBJECTIVE
In the present paper, we report and discuss the recognition and the management of drug-induced acute neutropenia or agranulocytosis (neutrophil count of < 0.5 x 10(9)/l).


METHODS
A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to January 2008. Additional not published data of our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were incorporated in this review.


CONCLUSIONS
Idiosyncratic drug-induced acute neutropenia or agranulocytosis is a serious adverse event due to the frequency of severe infections (such as deep infections, septicemia and septic shock) but modern management with broad spectrum antibiotics and hematopoietic growth factors is likely to improve the prognosis. Given the increased life expectancy, increasing use of medications as a therapeutic modality and subsequent longer exposure to drugs, as well as the development of new agents, healthcare professionals should be aware of this adverse event and its management.
Andrès
Emmanuel
E
Hôpitaux Universitaires de Strasbourg, Service de Médecine Interne, Clinique Médicale B, Hôpital Civil, 1 Porte de l'Hôpital, 67 091 Strasbourg Cedex, France. emmanuel.andres@chru-strasbourg.fr
Federici
Laure
L
Weitten
Thierry
T
Vogel
Thomas
T
Alt
Martine
M
D000208:Acute Disease; D000380:Agranulocytosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D006397:Hematinics