AGRANULOCYTOSIS

General Information

DEFINITION--Reduction in the normal number of circulating white blood cells (granulocytes or neutrophils) in the bloodstream. These cells are the first to attack bacterial infections.

BODY PARTS INVOLVED--Blood; bone marrow.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Fever.
• Aching.
• Sore throat.
• Ulcers (especially in the mouth and throat), which do not produce pus.
• Any sign of infection in someone who has had agranulocytosis in the past. This may signal a recurrence.

CAUSES--Increased destruction or impaired production of granulocytes (white blood cells). The most common reason for this is an adverse reaction to medications, including: anticancer drugs; anticonvulsants; antihistamines; antithyroid drugs; arsenic; chloramphenicol; Dibenzyline; gold salts; indomethacin; nitrofurantoin; nitrous oxide; phenothiazines; phenylbutazone; procainamide; sulfonamides; synthetic penicillins; and thiazide diuretics.

RISK INCREASES WITH--Genetic factors. A rare form, infantile genetic agranulocytosis, is inherited.

HOW TO PREVENT

• See your doctor if you have one infection after another (especially if you take medications).
• Prevent recurrences by avoiding any suspect medicine or drug that may have triggered agranulocytosis previously.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies of blood and bone marrow, and cultures of blood, nose, throat and urine.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Possible hospitalization for intensive treatment during the active phase, with strict reverse isolation techniques (See Glossary) and transfusions of white blood cells (sometimes).
• Self-care after diagnosis and hospitalization.

> Dangerous, sometimes fatal infections (bacterial, fungal, viral or others)--

even with vigorous treatment.

• May be an early sign of leukemia or aplastic anemia.

PROBABLE OUTCOME--Depending on cause, usually curable with intensive treatment.

How To Treat

GENERAL MEASURES----Hospitalization may be necessary during the acute phase. The following may be helpful after hospitalization:

• Be extra careful about personal cleanliness.
• Keep the mouth clean by rinsing frequently with warm salt water (1 teaspoon salt to 8 oz. water) or gargling with hydrogen peroxide.
• Pay particular attention to oral hygiene. Brush teeth gently with a very soft brush, avoiding irritation of the gums.
• Avoid contact with harmful materials, such as cleaning chemicals, glue, insecticide, fertilizer and paint remover.

MEDICATION--Your doctor may:

• Prescribe intravenous and oral antibiotics if the white blood cell count is very low.
• Prescribe lithium to stimulate bone marrow to produce more granulocytes.
• Stop prescribing any drug that is suspected of causing agranulocytosis.

ACTIVITY--Rest in bed during the acute stage. Resume normal activities gradually after symptoms subside.

DIET--No restrictions.

Call Your Doctor If

• You have symptoms of agranulocytosis.
• The following occurs after treatment: Any sign of infection, especially fever. Swelling of the feet and ankles. Painful urination or decreased urine output in 1 day.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.