Agranulocytosis, A Simple Guide to The Condition, Diagnosis, Treatment And Related Conditions

by Kenneth Kee

Overview

Agranulocytosis

Agranulocytosis is a dangerous condition which can occur from exposure to chemotherapy.

One of my patients with lung cancer had just died from severe infection following the loss of white blood cells following her chemotherapy.

What is Agranulocytosis?

Agranulocytosis is a medical disorder in which the bone marrow does not make enough of a certain form of mature white blood cells (neutrophils).

The bone marrow is the blood producing tissue inside bones.

Agranulocytosis is a reduction in circulating neutrophils in the blood which forms 4-5% of total body neutrophil stores

Most of the neutrophils are stored in the bone marrow, either as mitotically active (one third) or post-mitotic mature cells (two thirds)

Granulocytopenia is defined as a reduced number of blood granulocytes such as neutrophils, eosinophils, and basophils.

Agranulocytosis is frequently used synonymously with neutropenia and is therefore confined to the neutrophil lineage alone.

The danger of serious infection rises as the absolute neutrophil count (ANC) drops to the severely neutropenic range (< 500/µL).

The period and severity of neutropenia is directly linked with the total incidence of all infections and of those infections that can threaten life.

Causes

Agranulocytosis may be due to:

1. Autoimmune disorders2. Bone marrow diseases, such as myelodysplasia or large granular lymphocyte (LGL) leukemia3. Certain medicines used to treat diseases4. Chemotherapy5. Certain street addiction drugs6. Poor nutrition7. Preparation for bone marrow transplant8. Genetic problems

Agranulocytosis results in a person not having enough of a specific form of white blood cells, such as neutrophils or granulocytes.

A low neutrophil count may also happen when white blood cells are destroyed faster than they can be produced.

Symptoms

People with this disorder tend to have fevers and infections.

Frequent presenting symptoms of neutropenia are:

1. Low-grade fever2. Sore mouth3. Odynophagia4. Gingival pain and swelling5. Skin abscesses6. Recurrent sinusitis and otitis7. Symptoms of pneumonia (e.g., cough, dyspnea)8. Perirectal pain and irritation

Patients with agranulocytosis normally present with:

1. Sudden onset of malaise2. Sudden onset of fever, possibly with chills and prostration3. Stomatitis and periodontitis together with pain4. Pharyngitis, with difficulty in swallowing

Lung infections are normally bacterial or fungal pneumonias.

Physical signs on evaluation of a patient with agranulocytosis are:

1. Fever2. Stomatitis3. Periodontal infection4. Cervical lymphadenopathy5. Skin infection: The skin examination focuses on rashes, ulcers, or abscesses6. Splenomegaly7. Related petechial bleeding8. Perirectal infection9. Growth retardation in children

In agranulocytosis, the following may be present:

1. Fever (often 40°C or higher)

2. Rapid pulse and respiration

3. Hypotension and signs of septic shock if infection has been present

4. Painful aphthous ulcers in the oral cavity

5. Swollen and tender gums

Diagnosis

The diagnosis of agranulocytosis requires the exclusion of infectious and drug-induced causes of neutropenia through the following laboratory tests:

1. Full blood count: Including a differential count in assessing patients of agranulocytosis

2. Differential white blood cell count

3. Peripheral smear review by a pathologist

The following studies apply to some patients with neutropenia:

1. Antinuclear antibody

2. Rheumatoid factor

3. Serum immunoglobulin studies

4. Liver function tests

5. Peripheral blood flow cytometry

6. T-cell gene rearrangement for T-cell clonality

7. Paroxysmal nocturnal hemoglobinuria testing:

By high-sensitivity or fluorescent aerolysin (FLAER)–based flow cytometry

8. Antineutrophil antibodies:

Tne marrow aspiration or a biopsy from the posterior iliac crest should be obtained.

Product Details

BN ID:	2940152391435
Publisher:	Kenneth Kee
Publication date:	10/04/2015
Sold by:	Smashwords
Format:	eBook
File size:	125 KB

About the Author

Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor" “The Amazing Story of the Cold Sore Virus” “Of Bed Bugs, Lice And Scabies! Skin Infections” “A Simple Guide to Sexual Health” “A Simple Guide To Cancer” “A Simple Guide to Skin Polyp and Other Polyps” “A Simple Guide to Sexually Transmitted Diseases” “A Simple Guide To Stroke” “A Simple Guide to Women's Health” “A Simple Guide to Men's Health” “A Simple Guide to AutoImmune Diseases” “A Simple Guide to Alternative Therapy” “A Simple Guide to Alzheimer's Disease and Dementia” “A Simple Guide to Hypertension and Heart Diseases” “A Simple Guide To Liver Diseases” “A Simple Guide to Diabetes Mellitus and Diabetes Insipidus” “A Simple Guide to Skin Fungal Infections” “A Simple Guide to Hemorrhoids and Anal Diseases” “A Simple Guide to Genetic Diseases” “A Simple Guide to Vitamins, Minerals and Health” “A Simple Guide to Kidney Stones and Kidney Diseases” “A Simple Guide to Asthma and Lung Diseases” “A Simple Guide to Allergies” “A Simple Guide to Eating Disorders” “A Simple Guide to Thyroid Diseases” “A Simple Guide to Sleep Disorders” “A Simple Guide to Bad Breath 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Related Diseases and Use in Disease Diagnosis” “A Simple Guide to Heart Valve Diseases” “A Simple Guide to Congenital Heart Diseases” “Life and Death of a Red Blood Cell (Red Bull)” “Life and Death of a Sperm (Speedy Gonzales)” “Life and Death of an Ovum (Lazy Lucy)” “Life and Death of a Lymphocyte (Immune Man)” “Life and Death of a Cancer Cell (Mutant)” “Life and Death of a Nerve Cell (Motor Man)” “Life and Death of a Skeletal Muscle Cell (Muscle Man)” “Life and Death of a Heart Muscle Cell (Heart Man)” “Life and Death of a Smooth Muscle Cell (Smooth Man)” “Life and Death of a Hair Follicle Cell (Hairy Man)” “Life and Death of a Liver Cell (Liver Man)” “Life and Death of a Bone Cell (Bone Man)” “Life and Death of a Nail (Nail Man)” “Life and Death of a Macrophage (Macrophage)” “Life and Death of a Skin Cell (Skin Man)” “Life and Death of a Pancreatic Islet Cell (Insulin Man)” “Life and Death of a Pancreatic Duct Cell (Pancreas Man)” “Life and Death of a Pituitary Gland Cell (Pituitary 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