MyMedR

The use of the sulphonamide group in gynaecology and midwifery

English JS

Journal of the Malaya Branch of the British Medical Association, 1939;3:93-94.

Matched MeSH terms: Agranulocytosis

Carbimazole-induced agranulocytosis treated with granulocyte-macrophage colony stimulating factor--a case report

Ng SC

Ann Acad Med Singap, 1995 May;24(3):465-6.

Drug-induced agranulocytosis is a potentially fatal complication despite advances in supportive care. A patient with carbimazole-induced agranulocytosis associated with marked depletion of granulocytic precursors in the marrow was treated with granulocyte-macrophage colony stimulating factor (GM-CSF) at a dose of 5 micrograms/kg subcutaneously daily for one week. The absolute neutrophil count rose above 1 x 10(9)/L after one week of GM-CSF therapy. The GM-CSF probably expedited the recovery of the neutrophil count. Further studies are warranted to delineate the role of GM-CSF in the treatment of drug-induced agranulocytosis.

Matched MeSH terms: Agranulocytosis/chemically induced*; Agranulocytosis/therapy*

Fulltext Agranulocytosis monitoring with Clozapine patients: to follow guidelines or to attempt therapeutic controversies?

Chandrasekaran PK

Singapore Med J, 2008 Feb;49(2):96-9.

PMID: 18301833

Clozapine is an atypical antipsychotic with superior efficacy in the treatment of refractory schizophrenia. But it can cause agranulocytosis, which occurs in one to two percent of patients. This paper was prepared to discuss the condoned and controversial issues of therapy with this drug, but only within a haematological context. The feasibility of attempting therapeutically controversial blood monitoring regimes, as opposed to following standardised Western guidelines, given the differences in terms of accessibility, convenience and financial considerations between the public and private sector medical care will also be discussed. The proposal of adopting a structured pro forma, with a risk-benefit assessment, in the event of unavoidable veering from the guidelines may allay medicolegal implications, especially in countries where blood monitoring is not mandatory. It is hoped that this article will stimulate further research in our region, bearing in mind the increasing awareness and focus on genetic polymorphism, and the possibility of drawing up our own monitoring guidelines in the near future.

Matched MeSH terms: Agranulocytosis/chemically induced*; Agranulocytosis/diagnosis

Necrotizing gingivitis: a possible oral manifestation of ticlopidine-induced agranulocytosis

Rajandram RK, Ramli R, Karim F, Rahman RA, Fun LC

N Z Med J, 2007;120(1256):U2590.

PMID: 17589558

Agranulocytosis is a rare complication of ticlopidine and can be life-threatening. We report a case of ticlopidine-induced agranulocytosis and neutropenia (neutrophil count of 0.1 x 10(9)/L) with necrotizing gingivitis in a 54-year-old Malaysian-Chinese female. She was started on ticlopidine 250 mg twice daily 3 weeks prior to this hospital admission. We started her on intravenous metronidazole and amoxicillin and clavulanic acid (Augmentin) and concurrently stopped ticlopidine. A series of clinical and laboratory investigations were carried out and a final diagnosis of necrotizing gingivitis possibly secondary to agranulocytosis was made. The patient was discharged home after 2 weeks of hospitalisation.

Matched MeSH terms: Agranulocytosis/chemically induced*; Agranulocytosis/diagnosis*

Fulltext Clozapine-induced constipation: a case report

Teh, Y.W., Teh, E.E., Russell, V.

Malaysian Journal of Psychiatry, 2014;23(1):77-80.

MyJurnal

Clozapine is an atypical antipsychotic medication, used primarily as the drug of choice in treatment resistant schizophrenia. Despite its considerable advantages, clozapine’s licence is restricted because of its potential to induce agranulocytosis. Hence, white blood cell count monitoring is mandatory in patients receiving clozapine treatment. A side effect of clozapine that has received relatively less attention is constipation, which is caused by the drug’s anticholinergic effect. This potentially serious problem can result in life- threatening bowel obstruction, ischemia, necrosis, perforation, and pulmonary aspiration. Despite this evidence, routine inquiry about constipation in clozapine treated patients is not emphasised in current clinical guidance. We report a case to highlight constipation as both a potentially serious side effect and as a factor, insufficiently recognised, in non-adherence to clozapine.

Matched MeSH terms: Agranulocytosis

Fulltext Clozapine and Polycythemia Rubra Vera: a rare side effect or a separate medical condition? – a case report

Tan, H.P.J.

Malaysian Journal of Psychiatry, 2016;25(2):0-0.

MyJurnal

This article highlights the case of a 44-year old Malay man who is diagnosed as having treatment resistant schizophrenia on Clozapine, which then developed Polycythemia Rubra Vera (PRV). It is known that a major side effect for Clozapine is of agranulocytosis, that is a potentially fatal side effect. However, there have been reported disturbances of other hematological parameters, which result in other abnormalities including leucopenia, leucocytosis, thrombocytopenia, thrombocytosis and eosinophilia. Could this case be a pure medical condition of PRV or is there a relation to the effects of Clozapine? In this paper, the aim is to report a case of blood dyscrasia in a 44-year old male who developed Polycythemia Rubra Vera a year after he was observed to have abnormal full blood count results.

Matched MeSH terms: Agranulocytosis

Essential thrombocytopenia

Haridas G

Journal of the Malaya Branch of the British Medical Association, 1940;4:198-204.

Matched MeSH terms: Agranulocytosis

Fulltext Carbimazole-induced aplastic anaemia - a case report

Vijay AP, Lim SS, Tan ATB, Rokiah P, Chan SP

JUMMEC, 2009;12(2):92-95.

MyJurnal

Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well, but some may develop rare life threatening side effects such as agranulocytosis and aplastic anaemia. Clinical experience with the latter condition is extremely limited. We report on a case of carbimazole-induced aplastic anaemia caused by hypocellular bone marrow and associated plasmacytosis in a thyrotoxic patient chronically treated with carbimazole. This resolved after substitution with propylthiouracil. The clinical course was complicated by neutropaenic septicaemia and atrial fibrillation.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Agranulocytosis

Fulltext Clozapine-induced fatal bowel ischaemia - a neglected side effect?

Razak, N.A., Mohd Nor, F., Shafie, M.S., Hwang, I.S.

Malaysian Journal of Psychiatry, 2017;26(1):0-0.

MyJurnal

There have been previous reported deaths due to clozapine-induced
constipation. In all these cases, patients have experienced prior abdominal
symptoms over a period of weeks or months. Clozapine is an anti-psychotic
drug, and it is widely used for treatment of schizophrenia. The important
side-effects of clozapine include postural hypotension, weight gain,
tachycardia, cardiomyopathy, cardiomyositis, seizures, hypersalivation and
agranulocytosis. However, constipation induced by clozapine need to be
addressed since it may cause fatal consequences. Constipation associated with
clozapine is thought to be mediated by the drugs' pronounced dosedependent
cholinergic and serotonergic antagonism. Hence, a clozapineinduced
rapidly fatal bowel ischaemia is the highlight of this report and this
risky side-effect should be aware by the psychiatrist or physician before
commencing the treatment.

Matched MeSH terms: Agranulocytosis

Fulltext Hypocalcemia, hypochloremia, and eosinopenia as clinical predictors of leptospirosis: A retrospective study

Fish-Low CY, Balami AD, Than LTL, Ling KH, Mohd Taib N, Md Shah A, et al.

J Infect Public Health, 2020 Feb;13(2):216-220.

PMID: 31455598 DOI: 10.1016/j.jiph.2019.07.021

BACKGROUND: Underestimation of leptospirosis cases is happening in many countries. The most common factor of underreporting is misdiagnosis. Considering the limitations of direct detection of pathogen and serological diagnosis for leptospirosis, clinical features and blood tests though non-specific are usually referred in making presumptive diagnosis to decide disease management.

METHODS: In this single-centre retrospective study, comparative analysis on clinical presentations and laboratory findings was performed between confirmed leptospirosis versus non-leptospirosis cases.

RESULTS: In multivariate logistic regression evidenced by a Hosmer-Lemeshow significance value of 0.979 and Nagelkerke R square of 0.426, the predictors of a leptospirosis case are hypocalcemia (calcium <2.10mmol/L), hypochloremia (chloride <98mmol/L), and eosinopenia (absolute eosinophil count <0.040×109/L). The proposed diagnostic scoring model has a discriminatory power with area under the curve (AUC) 0.761 (p<0.001). A score value of 6 reflected a sensitivity of 0.762, specificity of 0.655, a positive predictive value of 0.38, negative predictive value of 0.91, a positive likelihood ratios of 2.21, and a negative likelihood ratios of 0.36.

CONCLUSION: With further validation in clinical settings, implementation of this diagnostic scoring model is helpful to manage presumed leptospirosis especially in the absence of leptospirosis confirmatory tests.

Matched MeSH terms: Agranulocytosis/blood*

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