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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.


  • 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.


  • 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


  • 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.


  • 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.
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