No abstract available.
Agranulocytosis*

The novel antipsychotic, olanzapine, has structural and pharmacological properties similar to clozaine. Antipsychotic drugs, as well as mood stabilizers, can cause neutropenia, which can progress to life-threatening agranulocytosis if the medication is not discontinued. We report two cases of reversible neutropenia associated with a olanzapine-valproate combination treatment. This report suggests that patients treated with the combination of olanzapine and valproate should be monitored for the occurrence of leukopenia and neutropenia.
Agranulocytosis ; Antipsychotic Agents ; Benzodiazepines ; Humans ; Leukopenia ; Neutropenia ; Valproic Acid

Antipsychotic-induced agranulocytosis is a significant side effect that is known to occur with most of the antipsychotic medications. It usually resolves once the medications are stopped and patients are able to be switched over to another antipsychotic medication. Lurasidone has not been reported to cause leukopenia and neutropenia. This case report is of a patient with a past history of risperidone induced-aganulocytosis developing dose related leukopenia and neutropenia with lurasidone.
Agranulocytosis ; Antipsychotic Agents* ; Humans ; Leukopenia ; Lurasidone Hydrochloride* ; Neutropenia* ; Risperidone

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

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*

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*

PURPOSE: Doxorubicin/cyclophosphamide followed by docetaxel chemotherapy (AC-D) is an intermediate risk factor (incidence of 10%–20%) for febrile neutropenia (FN) in breast cancer. However, the reported incidence of FN while using this regimen was obtained mostly from Western breast cancer patients, with little data available from Asian patients. This study aimed to assess the incidence of FN in Korean breast cancer patients and to describe clinical variables related to FN. METHODS: From September 2010 to February 2013, data from the Yonsei Cancer Center registry of breast cancer patients who received neoadjuvant or adjuvant chemotherapy with four cycles of AC-D (60 mg/m2 doxorubicin, 600 mg/m2 cyclophosphamide every 3 weeks for four cycles followed by 75 mg/m2 or 100 mg/m2 docetaxel every 3 weeks for four cycles) were analyzed. The incidence of FN, FN associated complications, dose reduction/delays, and relative dose intensity (RDI) were investigated. RESULTS: Among the 254 patients reported to the registry, the FN incidence after AC-D chemotherapy was 29.5% (75/254), consisting of 25.2% (64/254) events during AC and 4.7% (12/254) during docetaxel chemotherapy. Dose reductions, delays, and RDI less than 85.0% during AC were observed in 16.5% (42/254), 19.5% (47/254), and 11.0% (28/254) of patients, respectively. Patients with FN events frequently experienced dose reduction/delays, which eventually led to a decreased RDI. CONCLUSION: The incidence of FN during AC-D neoadjuvant or adjuvant chemotherapy was higher than expected in Korean breast cancer patients. Whether these patients should be classified as a high-risk group for FN warrants future prospective studies.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chemotherapy-Induced Febrile Neutropenia ; Cyclophosphamide ; Doxorubicin ; Drug Therapy* ; Febrile Neutropenia* ; Female* ; Humans ; Incidence* ; Prospective Studies ; Risk Factors

Neutropenia and agranulocytosis are dangerous conditions seldom caused by antipsychotics. We report the case of a 35-year-old female patient who presented with neutropenia following ziprasidone administration. Ziprasidone was gradually increased to 160 mg/day in combination with escitalopram 10 mg/day. Following ziprasidone administration, her neutrophil count fell to 1700x10(3)/mm3, on day 45 and to 1500x10(3)/mm3 on day 57. Ziprasidone was immediately stopped, and quetiapine 25 mg was given from the next day onward, along with the escitalopram. Her neutrophil count rose to 2700x10(3)/mm3 2 days later, and was maintained at 2,900x10(3)/mm3 at 17 days after changing medication. To the best of our knowledge, this case represents the first report of ziprasidone - induced neutropenia in Korea. Further study is necessary to determine the incidence of neutropenia and its relationship with agranulocytosis secondary to ziprasidone.
Adult ; Agranulocytosis ; Antipsychotic Agents ; Citalopram ; Female ; Humans ; Incidence ; Korea ; Neutropenia* ; Neutrophils ; Quetiapine Fumarate

BACKGROUND: Iron overload is a predictable and life-threatening complication in patients dependent on the regular transfusion of RBCs. The aims of this study were to investigate the efficacy and safety of deferiprone in a variety of pediatric hematologic and/or oncologic patients with a high iron overload. METHODS: Seventeen patients (age: 1.1-20.4 years; median: 10.6 years) from 7 hospitals who were treated with deferiprone from 2006 to 2009 were enrolled in this study. Medical records of enrolled patients were reviewed retrospectively. RESULTS: Serum ferritin levels were 4,677.8+/-1,130.9 microgram/L at baseline compared to 3,363.9+/-1,149.7 microgram/L at the end of deferiprone treatment (P=0.033). Only 1 patient developed neutropenia as a complication. CONCLUSION: Deferiprone treatment is relatively safe for pediatric patients suffering from various hematologic and oncologic diseases that require RBC transfusions as part of treatment. However, the potential development of critical complications such as agranulocytosis and/or neutropenia remains a concern.
Agranulocytosis ; Ferritins ; Humans ; Iron ; Iron Overload ; Medical Records ; Neutropenia ; Pyridones ; Stress, Psychological

No abstract available.
Agranulocytosis* ; Granulocytes* ; Humans