1.2 - Agranulocytosis and other blood dyscrasias  pp. 12-17

Agranulocytosis and other blood dyscrasias

By David M. Gardner, Michael D. Teehan and Ross Baldessarini

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Background

With the exception of clozapine-induced granulocytopenia and agranulocytosis, most antipsychotic-induced hematological effects are rare and remain poorly characterized. The true incidence of antipsychotic-induced blood dyscrasias has not been estimated accurately.

Antipsychotic agents have been associated with numerous blood dyscrasias, including thrombocytopenia, leukopenia, neutropenia, and agranulocytosis. The mechanism by which antipsychotic agents induce hematological toxicities is currently unknown.

Complications of various blood dyscrasias can be severe, even life-threatening. Leukopenia, neutropenia, and agranulocytosis can result in systemic infections and/or death, while profound thrombocytopenia can represent a significant risk of abnormal bleeding.

Agents of interest

Second-generation antipsychotic agents

Aripiprazole

In the premarketing evaluation of aripiprazole, leukopenia, neutropenia, and thrombocytopenia occurred at a rate of between 0.1% and 1%.

There is at least one published case of leukopenia associated with aripiprazole and a case of leukopenia and thrombocytopenia associated with the addition of aripiprazole to phenytoin.

Clozapine

Granulocytopenia and agranulocytosis are well-documented adverse effects associated with clozapine use. The incidence of granulocytopenia is 3%, and the incidence of agranulocytosis is 0.7–0.9%. When agranulocytosis occurs with clozapine, the mortality rate is estimated to be 3–4%.

The risk of agranulocytosis is much greater with clozapine than with other antipsychotics, including risperidone, olanzapine, quetiapine, and the first-generation agents.

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