Drug-induced agranulocytosis: experience in two university hospitals.

STUDY

OBJECTIVE

to describe demographic data, offending drugs, clinical features, hematological profiles, clinical course, general outcome, factors influencing fatal result and microbiological aspects

DESIGN

Retrospective descriptive analysis

SETTING

Two university hospitals

PATIENTS: 28 patients with 31 episodes of drug-induced agranulocytosis from Chulalongkorn Hospital (1976-1988) and 24 patients with 25 episodes from Songklanagarind Hospital (1983-1989)

RESULTS

Female exceeds male by ratio of 2.1:1, age ranged 15-73 years. The common drugs were antimicrobial agents, penicillins and sulfonamides; antithyroid drugs; antituberculous drugs and non-steroidal antiinflammatory drugs (NSAIDs), unidentified in 16 per cent. About 61 per cent occurred more than 14 days after drug exposure. The key presentations revealed fever, prostration and sorethroat. Two marrow appearances were recognised: left-shifted granulopoiesis with few or no mature forms (type-I) in 66 per cent; and the other, selective reduction of granulocytic precursors (type-II). Penicillins, sulfonamides, antithyroid drugs and NSAIDs were all related to type-I. The leukocyte count, neutrophil and monocyte numbers were significantly higher in type-I, as well much more rapid recovery time (mean +/- SD, 4.4 +/- 1.5 vs 12.4 +/- 14.1 days, p = 0). The possible sites of infection were identified in 59 per cent, the major ones were oral cavity and GI tract. The organisms were isolated in 58 per cent from the primary sites and 25 per cent from hemocultures, of which Pseudomonas aeruginosa was the most common. The case fatality rate is 12.5 per cent. The dead victims had the higher age, and strongly association with type-II marrow appearance (p = 0.038).