Clinical presentation and management of drug-induced agranulocytosis

Expert Rev Hematol. 2011 Apr;4(2):143-51. doi: 10.1586/ehm.11.12.


Objective: In this article, we report and discuss the clinical presentation and management of idiosyncratic drug-induced agranulocytosis (neutrophil count <0.5 × 10(9)/l).

Results/conclusions: Idiosyncratic drug-induced agranulocytosis remains a potentially serious adverse event owing to the frequency of severe sepsis with severe deep tissue infections (e.g., pneumonia), septicemia and septic shock in approximately two-thirds of all hospitalized patients. However, several prognostic factors have recently been identified that may be helpful in practice to identify 'susceptible' patients. Old age (>65 years), septicemia or shock, metabolic disorders such as renal failure and a neutrophil count below 0.1 × 10(9)/l are currently consensually accepted as poor prognostic factors. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly granulocyte colony-stimulating factor) is likely to improve prognosis. Thus, with appropriate management, the mortality rate from idiosyncratic drug-induced agranulocytosis is currently approximately 5%.

MeSH terms

  • Age Factors
  • Agranulocytosis / chemically induced
  • Agranulocytosis / diagnosis*
  • Agranulocytosis / therapy
  • Anti-Bacterial Agents / adverse effects
  • Antithyroid Agents / adverse effects
  • Diagnosis, Differential
  • Fibrinolytic Agents / adverse effects
  • Granulocyte Colony-Stimulating Factor / physiology
  • Granulocyte-Macrophage Colony-Stimulating Factor / physiology
  • Humans
  • Leukocyte Count
  • Neutrophils / cytology
  • Neutrophils / immunology
  • Pneumonia / complications
  • Renal Insufficiency / complications
  • Risk Factors
  • Sepsis / complications


  • Anti-Bacterial Agents
  • Antithyroid Agents
  • Fibrinolytic Agents
  • Granulocyte Colony-Stimulating Factor
  • Granulocyte-Macrophage Colony-Stimulating Factor