Agranulocytosis Diagnosis and Causes

Causes of Agranulocytosis

Agranulocytosis Causes

1. Endocrinal causes like hyperpituitarism, hypoadrenalism.

2. Agranulocytosis due to drugs: This is a very important cause and is related to dosage of drugs as well as sensitivity reaction. The main drugs are:

• Anti­cancer drugs
• Anti-inflmmatory drugs
• Phenothiazines and tranquilizers
• Sulfonamides and cotrimoxazole
• Anti­thyroid drugs
• Anti­diabetic drugs
• Anti­histaminics
• Anti­epileptic drugs
• Anti­microbial agents

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Agranulocytosis Diuretics:

• Defiiency of vitamin B12 and folate
• It is caused due to obliteration of bone marrow due to myelofirosis, lymphoma and sarcoma.
  It is caused due to bone marrow damage due to X­ray radiation.
• Due to viral infections, i.e. hepatitis, HIV, inflenza, EBV
• Due to bacterial infections, i.e. enteric fever, tuberculosis and gram­negative bacterial septicemia
• Due to protozoal diseases, i.e. malaria and Kala­azar.
• Due to autoimmune diseases i.e. SLE, chronic autoimmune neutropenia
• Congenital i.e. in Kostmann’s syndrome

Agranulocytosis Clinical Manifestations

• Females are more commonly affcted than males
• Early manifestations of agranulocytosis are may be in form of sore throat or pain.
• In large number of cases ulceromembranous lesions appear on throat, tonsils, gum, tongue and genitalia
• These are often covered with grayish black exudates and may become gangrenous.
• Lymph gland generally cervical groups and in some, there are generalized lymphadenopathy
• Liver and spleen may become enlarged.
• As disease progresses severe toxemia develops and patient may go into shock.

Agranulocytosis Management

• Firstly, the cause is removable which is identifible.
• Secondly, the infection is controlled and patient is put on isolation ward and barrier nursing is done.
• Anti­bacterial drugs such as penicillin 5 mega units IM or IV 4 hourly or ciproflxacin 500 mg IV 4 hourly is started immediately.
• In addition metrogyl 500 mg every 6 hourly to take care of infection
• Anabolic steroids are also given.
• In cases where toxemia is severe corticosteroids are employed, i.e. injection dexamethasone 4 mg IV 6 hourly.
• Granulocytes transfusion is given to tide over crisis. This
  is given daily for 5–7 days.

Diagnosis Of Agranulocytosis

The diagnosis of agranulocytosis is based on clinical history and physical examination.

• In large number of cases ulceromembranous lesions are present on throat, tonsil, gums, tongue and genitalia. The lesions are covered with grayish black exudates and become gangrenous.
• Confirmation of diagnosis is made by laboratory investigations.
• Peripheral blood fim shows complete absence of neutrophils.
• Bone marrow is hypocellular and there is depletion of myeloid elements.