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Example sentences for: agranulocytosis
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SSZ has previously been associated with neutropenia with an estimated incidence of 0.04% during the first 30 days of treatment [ 34 ] . Bone marrow biopsy specimens of patients with SSZ induced agranulocytosis reveal a paucity of myeloid cells but full recovery typically occurs within 10 days of drug discontinuation [ 35 36 37 ] . Although our patient had adequate myeloid cells in her bone marrow biopsy, she developed absolute neutropenia by hospital day #19 that improved with steroid therapy.
In cases of fulminant hepatic failure and agranulocytosis, several patients have died despite the use of steroids [ 27 28 37 ] . Intravenous immunoglobulin was reported as a successful "rescue" therapy in a patient with SSZ induced fulminant hepatic failure and erythroid hypoplasia who had not responded to steroids [ 25 ] . Due to the infrequent occurrence of severe SSZ toxicity that does not improve with drug discontinuation, it is unlikely that randomized controlled trials of steroids or other interventions will be performed.
Clozapine is a widely used atypical neuroleptic with affinity for multiple receptors, including dopamine, serotonin, alpha adrenergic, muscarinic and histaminergic receptors [ 1 2 ] . Although clozapine is effective in the treatment of schizophrenia refractory to traditional antipsychotic medication, it also has a number of significant side effects ranging from the potentially fatal but rare agranulocytosis to weight gain, constipation, seizures and urinary incontinence [ 3 ] . Urinary problems have been reported in the clinical literature with incontinence present in up to 44% of patients [ 4 ] and enuresis in 27% of patients [ 5 ] . Since clozapine has potent anti-muscarinic and anti-alpha adrenergic effects [ 2 ] , it has been proposed that peripheral effects on the lower urinary tract might be responsible for the micturition disturbances [ 6 ] . Incontinence has also been reported following therapy with other atypical neuroleptics such as risperidone [ 7 8 9 ] and recently, olanzapine [ 10 ] .
SSZ induced agranulocytosis is believed to be mediated by immunological hypersensitivity of myeloid precursors [ 38 ] . Spontaneous recovery from SSZ agranulocytosis is frequently seen, although fatalities have been reported and some patients may benefit from granulocyte macrophage-colony stimulating factor [ 39 40 ] .
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