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The crisis hidden in drugs: Why do some drugs cause agranulocytosis?
Agranulocytosis, also known as agranulocytosis or granulocytopenia, is an acute and dangerous condition in which the number of white blood cells is significantly reduced. This decrease, which typically occurs in neutrophil white blood cells, wreaks havoc on patients' immune systems, putting them at high risk for serious infections. By definition, during an episode of agranulocytosis, the concentration of granulosa cells drops to less than 200 cells per cubic millimeter of blood.
Many drugs are associated with agranulocytosis, including antiepileptic drugs, antithyroid drugs, antibiotics, and some antipsychotic drugs.
Symptoms and signs
Symptoms of agranulocytosis may be silent, or may appear suddenly with fever, chills, and sore throat. Infections in certain organs may worsen rapidly (such as pneumonia, urinary tract infections, etc.) and even lead to rapid progression to sepsis.
Effects of drugs
Most cases of agranulocytosis are related to the use of specific medications. Medications that often trigger this condition include:
- Anti-epileptic drugs: such as carbamazepine and valproic acid
- Antithyroid drugs: such as carbimazole and propylthiouracil
- Antibiotics: such as penicillin and chloramphenicol
- Certain antipsychotics: especially clozapine
Experts recommend that patients taking these drugs should be aware of the symptoms of agranulocytosis-related infections, such as sore throat and fever.
The U.S. Centers for Disease Control and Prevention traced an outbreak of agranulocytosis among some cocaine users between March 2008 and November 2009 that was linked to leflunomide (levamisole) in the drug supply.
Diagnosis
Agranulocytosis is usually diagnosed through a complete blood test. During this test, the absolute neutrophil count will usually be less than 500 and may even drop to 0. To confirm agranulocytosis, doctors need to rule out other pathologies with similar symptoms, such as aplastic anemia or leukemia. This usually involves a bone marrow test, which shows a normal amount and type of cells but a lack of underdeveloped premyeloid cells.
Treatment
For patients without symptoms of infection, management includes ongoing monitoring of blood tests, discontinuation of suspected medications, and providing advice regarding the severity of fever. Although granulocyte transfusion can be considered, because granulocytes have a very short survival time in the circulation (approximately 10 hours), the effects of this approach are usually temporary and there are many potential complications.
Conclusion
A hidden danger of agranulocytosis is that it may arise from medications used in daily life, the side effects of which are often overlooked. As the variety of medications increases, more and more patients are at risk for agranulocytosis. Do we really understand all the potential dangers of the drugs we take?
