No abstract available.
Agranulocytosis*

No abstract available.
Agranulocytosis* ; Granulocytes* ; Humans

Preoperative preparation of the hyperthyroid patient for thyroidectomy is imperative to avoid perioperative complications due to severe thyrotoxicosis. The mainstay of preparation is the administration of anti-thyroid drugs (ATD). When ATDs cause adverse reactions, an alternative regimen to prepare the patient for definitive management is crucial. We present the case of a 35-year-old Filipino female with Graves’ disease who developed methimazole-induced agranulocytosis. She refused to undergo radioactive iodine (RAI) therapy. She was admitted for thyroidectomy with elevated thyroid hormone levels. She was rapidly prepared for thyroidectomy using high-dose steroid, beta-adrenergic blocker, propylthiouracil (PTU) and Lugol’s solution. The patient’s free thyroxine level decreased after 8 days of treatment, without complications. She then underwent an uneventful subtotal thyroidectomy. In conditions with very limited options, although contraindicated, administration of another ATD may be the last alternative for patients who developed agranulocytosis.
Hyperthyroidism ; Thyroidectomy ; Agranulocytosis ; Iodine

A 51-year-old Caucasian male developed Graves’ thyrotoxicosis following long-standing treatment for hypothyroidism. After a short period of treatment with carbimazole, he developed agranulocytosis and required total thyroidectomy. In this relevant case report, we review several pathogenetic mechanisms that explain the transformation of autoimmune hypothyroidism into Graves’ disease and the possible approaches to the management of agranulocytosis secondary to antithyroid medications. Further studies are required to determine the best way to manage severe thyrotoxicosis when agranulocytosis develops due to antithyroid medications.
Hypothyroidism ; Antithyroid Agents ; Carbimazole ; Agranulocytosis

Methimazole is a widely used and generally well-tolerated antithyroid agent. Adverse reactions occur in 1~5% of patients taking methimazole medication, but these are most commonly transient, benign leukopenia and a skin rash. Severe cholestatic jaundice, combined with agranulocytosis, has been known as a rare complication. Herein, a case of methimazole induced cholestatic jaundice, with agranulocytosis, is reported.
Agranulocytosis* ; Exanthema ; Humans ; Jaundice, Obstructive* ; Leukopenia ; Methimazole

No abstract available.
Agranulocytosis* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans*

Several blood dyscrasias associated with clozapine have been well known to clinicians and potentially life threatening agranulocytosis has been widely reported. However, there is little report regarding incidence, progression and associated features of eosinophilia associated with clozapine. In clinical studies, the onset of eosinophilia usually occurs artier 3 to 5 weeks of treatment and rarely were cases fatal with medical complication. We report the first case of severe eosinophilia, bilateral pleural effusion, asicites, hepatitis and cholecystitis associated with clozapine that would be fatal. Eosinophilia occurred after 19 days of treatment with clozapine and all the clinical conditions improved along with interruption of clozapine treatment. It is suggested that eosinophilia may be more severe side effort than has ether been known and close hematologic monitoring should be done during early treatment of clozapine.
Agranulocytosis ; Ascites* ; Cholecystitis ; Clozapine ; Eosinophilia* ; Ether ; Hepatitis* ; Incidence ; Pleural Effusion*

OBJECTIVE: Clozapine is effective in the treatment of refractory schizophrenic patients, but can cause reversible and fatal food dyscrasias. This study documents the incidence of agranulocytosis and neutropenia and the characteristics of patients with clozapine-inducted agranulocytosis. METHOD: An analysis was made of the hematological, demographic, and other characteristics data from Clozaril Patient Monitoring System(CPMS) data on 2139 patients on clozapine over about 3 years in Korea. RESULTS: During the study period, agranulocytosis developed in 11 patients and 9 (81.8%) patients occurred within 18 weeks. The cumulative incidence of this side effect was 0.57% at 6 months and 0.65% at 1 to 3 years and the crude incidence was 0.51%. Neutropenia occurred in 157 patients and 114(72.6%) ones developed within 18 weeks. The crude incidence of this blood abnormality was 6.9% at 1 year and 7.3% at 3 years. The cumulative incidence was 9.0% at 1 year and 28.7% at 3 years. The hazard rates far agranulocytosis and neutropenia peaked during the 3rd month and 2nd month, respectively. CONCLUSIONS: These results showed that the incidence of agranulocytosis in Korea may be lower than in USA and UK, at least during the early years of clozapine marketing. Also those suggest that the CPMS in Korea serves as a effective early warning system to promote the safety and benefits of clozapine.
Agranulocytosis* ; Clozapine ; Humans ; Incidence ; Korea ; Marketing ; Monitoring, Physiologic ; Neutropenia*

Agranulocytosis as a side effect of clozapine has been reported to be associated with initial phases of treatment, i.e., first six months. Agranulocytosis with clozapine during the initial phases of treatment has been linked to genetic vulnerability in the form of variations in the human leukocyte-antigen haplotypes. However, there is limited literature on late onset agranulocytosis with clozapine and this has very rarely been linked to human leukocyte-antigen haplotypes vulnerability. In this report we review the existing data on late onset agranulocytosis with clozapine and describe the case of a young man, who developed agranulocytosis with clozapine after 35 months of treatment and was found to have genetic vulnerability in form of being positive for HLA DR4. This case highlights underlying autoimmune immune mechanism in clozapine-induced agranulocytosis and the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with genetic vulnerability to develop this condition.
Agranulocytosis* ; Clozapine* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Haplotypes ; Humans ; Neutropenia

Clozapine is a well-known antipsychotic which causes hematologic adverse effects, specifically neutropenia and agranulocytosis (1-3% of patients). However, reports on blood dyscrasias like anemia and thrombocytosis after clozapine treatment are extremely rare. In some cases re-challenge of clozapine could lead to hematopoietic abnormality related to thrombocytopenia or thrombocytosis, which may be a result of an immune reaction. This case report suggests that clinicians should monitor platelet count after re-treatment with clozapine.
Agranulocytosis ; Anemia* ; Clozapine ; Neutropenia ; Platelet Count ; Thrombocytopenia ; Thrombocytosis*