Agranulocytosis, neutropenia or granulocytopenia is a blood disease that occurs when the count of blood granulocytes is low (neutrophils, eosinophils and basophils) and the body’s ability to fight germs, and with it, infections, decreases. Even bacteria that normally live in the mouth or digestive system can be potentially infectious in a case of agranulocytosis. It is a rare disease but can be serious and even fatal in some cases. Agranulocytosis occurs when the number of neutrophils is less than 1,000 – 1,500 cells/cubic millimeter of blood.
Could be:
– Mild: number of neutrophils is less than 1,000 – 1,500 cells/cubic millimeter of blood.
– Moderate: number of neutrophils is less than 500 – 1,000 cells/cubic millimeter of blood.
– Severe: number of neutrophils is less than 500 cells/cubic millimeter of blood.
Causes of agranulocytosis
Various disorders, drugs and other causes
Agranulocytosis can be caused by various reasons but the two main ones are:
– Destruction or use of neutrophils faster than the bone marrow’s ability to produce new cells.
– The production of neutrophils in the bone marrow is reduced.
In the first case, the destruction of neutrophils or overuse occurs due to the appearance of disorders such as:
– Bacterial infections: salmonellosis.
– Allergies.
– Pharmacological treatments: some medications such as those used for the treatment of hyperthyroidism such as methimazole and propylthiouracil; antibiotics such as vancomycin, penicillin G and oxacillin; antivirals such as ganciclovir and valganciclovir; antipsychotics such as clozapine and chlorpromazine.
– Immune disorders: granulomatosis with polyangiitis, lupus and rheumatoid arthritis.
In the second case it may be a consequence of:
– A cancer.
– Viral infections: chickenpox, Epstein-Barr, hepatitis A, B and C, HIV and measles.
– Radiotherapy or chemotherapy treatment.
– Bone marrow disorders: aplastic anemia. Myelodysplastic syndromes or myelofibrosis.
Other causes:
– Kostmann’s symptom. Also called severe congenital neutropenia, congenital agranulocytosis, Kostmann’s agranulocytosis or severe infantile neutropenia.
– Vitamin deficiency or malnutrition.
– Abnormalities of the spleen.
– Chronic idiopathic neutropenia (of unknown origin).
Symptoms of agranulocytosis
Does not have specific symptoms
This disease does not have specific symptoms, so it is important to consult with your doctor if a condition with these signs occurs:
– Fever of 38ºC or more.
– Chills and sweat.
– Severe cough.
– Shortness of breath.
– Sore or sores in the mouth.
– Pain in the throat.
– Changes when urinating.
– Stiffness in the neck.
– Vomiting.
– Diarrhea.
– Redness or inflammation in a skin injury (cut or scratch).
-Abnormal vaginal secretions.
– Bone pain.
– General weakness.
Diagnosis of agranulocytosis
Frequent and unusual infections
Doctors usually do not suspect agranulocytosis unless the patient has frequent and unusual infections. The specialist will order a blood test in which the low neutrophil count will indicate agranulocytosis or neutropenia. A chest x-ray, neutrophil antibody study, bone marrow biopsy, mouth ulcer biopsy, or urine culture may also be performed.
If the patient has abdominal discomfort, a computed tomography (CT) scan may be performed.
Treatment and medication of agranulocytosis
Eliminate the cause
Treatment is aimed at eliminating the cause that produces agranulocytosis or neutropenia. Treatment depends, of course, on each case and its severity. If it is due to a pharmacological cause, the treatment that causes the disease is withdrawn. If there is infection, the patient will be given antibiotics effective against the most common infectious microorganisms. If the cause is an autoimmune disorder, corticosteroids may be effective. Antithymocyte immunoglobulin, intravenously, can combat agranulocytosis if aplastic anemia exists.
Bone marrow transplant is only useful to treat leukemia or aplastic anemia that leads to agranulocytosis or neutropenia.
Prevention of agranulocytosis
Without prevention
Agranulocytosis cannot be prevented except in cases where the reason is malnutrition. In that case, following a balanced and healthy diet with sufficient vitamin intake can be preventive. Additionally, if you are taking treatment with drugs that can cause agranulocytosis, you should consult with your prescribing doctor.
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