Idiosyncratic drug-induced agranulocytosis: possible mechanisms and management

Am J Hematol. 2009 Jul;84(7):428-34. doi: 10.1002/ajh.21433.


The incidence of drug-induced neutropenia has not changed in the western hemisphere over the last 30 years. Yet, the drug panorama has changed considerably. This implies that host factors may play an intriguing role for this idiosyncratic reaction. The knowledge as to mechanisms for the reaction has advanced with emerging understanding of neutropoiesis and immune regulation. Nonetheless, it is still remarkably difficult to pinpoint why and how a drug causes this unexpected, severe adverse event in a patient. Patient characteristics, e.g. genetics, appear to be keys for better understanding, predictions and prevention. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Agranulocytosis / chemically induced*
  • Agranulocytosis / genetics
  • Agranulocytosis / immunology
  • Agranulocytosis / therapy*
  • Drug Interactions
  • Epigenesis, Genetic
  • Genetic Predisposition to Disease
  • Humans
  • Intercellular Signaling Peptides and Proteins
  • Lymphopenia / chemically induced
  • Neutropenia / chemically induced
  • Neutropenia / physiopathology
  • Reactive Oxygen Species / metabolism


  • Intercellular Signaling Peptides and Proteins
  • Reactive Oxygen Species