Agranulocytosis

Description of the disease

It is a decrease in granulocytes (white blood cells with granules), where mature, partially mature, and immature granulocytes are rapidly destroyed due to the effect of drugs. This can be caused by various drugs, more commonly agranulocytosis occurs due to the effect of analgesics and antipyretics (especially pyrazolone derivatives), nonsteroidal anti-inflammatory drugs, antithyroid drugs (e.g., propylthiouracil), sulfonamides, antiepileptic drugs, psychotropic drugs, etc.

Mechanism of development of agranulocytosis: the drug in the blood binds to proteins (small proteins), forming a complete antigen (foreign substance to the body). Nothing happens the first time. When such a drug repeatedly enters the body, the immune system starts producing antibodies against the formed antigen. All these antigens and produced antibodies settle on the surface of granulocytes and cause their lysis (destruction).

Symptoms

It is an urgent condition, therefore rapid assistance is necessary. Symptoms appear suddenly. It starts with acute fever with chills, ulceration of the oral mucosa/tonsils, in rare cases when the condition is poor – sepsis.

Diagnosis

A decrease in granulocytes is observed in a blood test, often down to zero. After discontinuing the drug, within 7-10 days, the granulocyte count recovers. A disturbance in the maturation of granulocytes is evident in the bone marrow, with predominance of promyelocytes. The maturation of other blood cells (erythrocytes, platelets) is normal.

Treatment

The patient is considered in the least contaminated with bacteria environment (complete antiseptic conditions), as the body should not have to fight infection. Antibiotics, granulocyte colony-stimulating factors, and granulocyte-macrophage colony-stimulating factors are administered.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology