Agranulocytosis (Granulocytopenia, Granulopenia, Neutropenia)

Undergoing chemotherapy treatment for cancerTaking certain drugsInfectionExposure to certain chemical toxins or radiationAutoimmune diseasesEnlargement of the spleenVitamin B-12 or folate deficiencyLeukemia or myelodysplastic syndromesAplastic anemia or other diseases of the bone marrowFamily history of certain genetic diseases Symptoms If you experience any of these symptoms do not assume it is due to agranulocytosis. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician. Rapid onset of fever, chills, jaundice , weakness, or sore throat Bacterial pneumoniaUlcers in the mouthBleeding gumsLow white blood cell countInfections, including fungal Diagnosis Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following: Blood test to determine white blood cell countUrine or other fluids may be tested for infectious agents if the person has a fever Bone marrow test ( biopsy and aspiration) Genetic tests may be needed in some peopleAntineutrophil antibodies may need to be tested for in people with autoimmune disease TreatmentTalk with your doctor about the best treatment plan for you. Treatment options include the following:

Leukocyte TransfusionTransfusion of white blood cells to replace deficit may be of benefit in certain people. Antibiotic TreatmentUsed to treat infection that could be causing agranulocytosis or resulting from agranulocytosis. White Blood Cell-stimulating FactorsDepending on the cause, some people may benefit from treatments with granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF). Remove Causative AgentRemove toxin/drug or treat primary disorder. Prevention To help reduce your chances of getting agranulocytosis, take the following steps: Talk to your doctor about preventive measures when receiving white blood cell-reducing therapies. White blood cell-stimulating treatments such as G-CSF or GM-CSFTreatments to prevent the loss of white blood cells RESOURCES: Marquette University School of Dentistryhttp://www.dental.mu.edu/oralpath/lesions/agranulocytosis/agranulocytosis.htm National Organization for Rare Disorders, Inc.http://www.rarediseases.org/ CANADIAN RESOURCES: British Columbia Ministry of Healthhttp://www.bchealthguide.org/kbase/nord/nord209.htm Canadian Family Physicianhttp://www.cfpc.ca/cfp/ References: Boulton F, Cooper C, Hagenbeek A, et al. Neutropenia and agranulocytosis in England and Wales: incidence and risk factors. American Journal of Hepatology . 2003 Apr;72(4):248-54. PubMed website. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=12666135 . Accessed December 18, 2006.

Hoffman R. et al. Hematology: Basic Principles and Practice .4th ed. Philadelphia: Elsevier, 2005. Mandell GL et al. Principles and Practice of Infectious Diseases . 6th ed. London: Churchill Livingstone, 2005. Tajiri J, Noguchi S, MurakamiT, Murakami N. Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cell count monitoring. Arch Intern Med . 1990 Mar 1;150(3). Archives of Internal Medicine website. Available at: http://archinte.ama-assn.org/cgi/content/abstract/150/3/621 . Accessed December 18, 2006. Tyson MC, Rosenthal N, Vogel P. The value of penicillin in the treatment of agranulocytosis caused by thiouracil. Blood . 1946;1(1):53-66. Blood Journal website. Available at: http://www.bloodjournal.org/cgi/content/abstract/1/1/53 . Accessed December 18, 2006. Last reviewed February 2008 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.