Abstract
Agranulocytosis is a rare, but serious and life-threatening hematologic disorder in elderly patients. Idiosyncratic drug-induced agranulocytosis (IDIA) has been classically defined by a neutrophil count below 0.5 × 109/L. The annual incidence of IDIA in Europe is about 1.6–9.2 cases per million inhabitants. Increasing age and female sex have been considered as risk factors for the development of this condition. Besides, it is well known that older people take on average more drugs than younger people. This condition is most often associated with the intake of antibacterial agents, antiplatelets, antithyroids, antipsychotics, antiepileptics and nonsteroidal anti-inflammatory drugs (NSAIDs). Initially, agranulocytosis may present without symptoms, but may quickly progress to a severe infection and sepsis. The causative drug should be immediately stopped. In febrile patients, blood cultures and where indicated, site-specific cultures should be obtained and early treatment with empirical broad-spectrum antibiotics started. Even with adequate treatment, the mortality rate is higher in elderly patients reaching up to 20%. Hematopoietic growth factors have proven to be useful as they shorten the duration of neutropenia. However, data on neutropenia and agranulocytosis in the elderly meeting the criteria of evidence-based medicine are still poor in the literature. This review analyzes the results of our experience as well as other published studies of the universal literature.
Highlights
Between 2015 and 2050, the proportion of people aged 60 and over will almost double in the world, from 12% to 22%
Agranulocytosis was initially defined as an important decrease in the number of absent granulocytes in circulating blood, resulting in at least an absolute neutrophil count of
Bone marrow examination can be of help in these cases; if the cellularity is normal with a late myeloid arrest, the danger from neutropenia is likely significantly reduced, and re-challenge or even continuation of the drug with careful monitoring may be possible
Summary
Between 2015 and 2050, the proportion of people aged 60 and over will almost double in the world, from 12% to 22%. According to the WHO, aging is the result from physical and psychological changes in the organism These changes lead to disturbances related to the reduction of functional capacities, and to the possible sequelae of the diseases from which the person may have suffered throughout their life. Drug-induced agranulocytosis, or severe neutropenia, has been classically defined by a neutrophil count below 0.5 × 109/L, usually health impairment and often severe infections [2]. Several factors have been associated with a poor prognosis: age ≥ 65 years, the presence of comorbid conditions such as chronic renal failure or systemic inflammatory diseases, absolute neutrophil count at diagnosis below 0.1 × 109 cells/L and severe infections [3,4,5]. That is why it is crucial to give special attention to elderly individuals
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
