Recognition and management of drug-induced blood cytopenias: the example of drug-induced acute neutropenia and agranulocytosis

Background: More than several hundred drugs, toxins, and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias. Objective: In the present paper, we report and discuss the recognition and the management of drug-induced acute neutropenia or agranulocytosis (neutrophil count of < 0.5 x 10(9)/l). Methods: A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to January 2008. Additional not published data of our cohort of drug-induced agranulocytosis in the University Hospital of Strasbourg, France were incorporated in this review. Results/conclusions: Idiosyncratic drug-induced acute neutropenia or agranulocytosis is a serious adverse event due to the frequency of severe infections (such as deep infections, septicemia and septic shock) but modern management with broad spectrum antibiotics and hematopoietic growth factors is likely to improve the prognosis. Given the increased life expectancy, increasing use of medications as a therapeutic modality and subsequent longer exposure to drugs, as well as the development of new agents, healthcare professionals should be aware of this adverse event and its management.