eMedicine Specialties > Hematology > Red Blood Cells and Disorders

Agranulocytosis: Follow-up

Author: Ariel Distenfeld, MD, Clinical Professor, Department of Medicine, New York University School of Medicine
Contributor Information and Disclosures

Updated: Dec 11, 2008

Follow-up

Further Inpatient Care

  • If septic shock occurs, move the patient to the intensive care unit (ICU).
  • Intubation may be required.

Further Outpatient Care

  • Observation and CBC monitoring at increasing intervals of patients with agranulocytosis after recovery

Transfer

  • If septic shock occurs, the patient should be transferred to the ICU.

Deterrence/Prevention

  • Caution patients to avoid any drug that was previously implicated in causing them agranulocytosis.
  • When prescribing new drugs to a patient with a history of a relatively high incidence of associated agranulocytosis, frequently obtain CBCs in the initial period.
    • The exact frequency depends on the specific drug and the time course of neutropenia association.
    • At the first sign of a drop in the ANC, the drug should be discontinued.

Complications

  • A metastatic abscess formation may result from infections, even if the infection was successfully resolved.

Prognosis

  • If treated promptly and vigorously, patients with drug-induced agranulocytosis have a good prognosis.
  • Agranulocytosis secondary to viral infections is usually self-limited, and patients with such conditions have a good prognosis.

Patient Education

  • Patients should be educated to avoid drugs that have caused them agranulocytosis.
  • Patients should be educated about the importance of follow-up CBC testing when a new drug with a high propensity to cause neutropenia is introduced.
  • In the workplace, people must be educated to follow regulations from the Occupational Safety and Health Administration (OSHA) that cover safety precautions when they deal with toxic substances.

Miscellaneous

Medicolegal Pitfalls

  • Failure to appropriately monitor blood cell counts
  • Failure to administer appropriate antibiotics
  • Failure to diagnose leukemia or other life-threatening diseases that may have a similar presentation

Special Concerns

  • Obtain a detailed history in patients with agranulocytosis, with particular emphasis on medication use. The inquiry must extend back in time to include discontinued medications.
  • Over-the-counter drugs must be included in the inquiry, because patients often do not consider these agents to be medications.
  • Any possible occupational or accidental exposure to toxic chemicals or physical agents must be excluded.
  • Agranulocytosis should be differentiated from other syndromes of bone-marrow failure, including pancytopenia and aplastic anemia. Leukemia should be excluded.
 


More on Agranulocytosis

Overview: Agranulocytosis
Differential Diagnoses & Workup: Agranulocytosis
Treatment & Medication: Agranulocytosis
Follow-up: Agranulocytosis
References
Further Reading
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Keywords

agranulocytosis, granulocytopenia, neutropenia, neutrophils, absolute neutrophil count, ANC, stomatitis, periodontitis, pharyngitis, autoimmune hemolytic anemia, idiopathic thrombocytopenic neutropenia, Kostmann syndrome, granulocyte colony-stimulating factor, G-CSF, ELA2

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Contributor Information and Disclosures

Author

Ariel Distenfeld, MD, Clinical Professor, Department of Medicine, New York University School of Medicine
Ariel Distenfeld, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Society of Blood Transfusion, International Society of Hematology, Medical Society of the State of New York, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Troy H Guthrie, Jr, MD, Director of Cancer Institute, Baptist Medical Center
Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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