Clozapine-induced anemia: A case-report
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Area of Science:

• Hematology
• Psychiatry
• Clinical Pharmacology

Background:

• Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia.
• While known for causing agranulocytosis, clozapine can also lead to other hematological abnormalities.
• This case focuses on a rare side effect: pure red cell aplasia.

Observation:

• A 36-year-old male patient with schizophrenia was switched to clozapine (400 mg/d).
• After 10 weeks, his hemoglobin dropped from 15.2 g/dL to 7.1 g/dL, with reticulocytopenia and normal white cell/platelet counts.
• Bone marrow biopsy revealed selective red cell hypocellularity, confirming pure red cell aplasia.

Findings:

• Clozapine treatment led to severe, selective anemia (pure red cell aplasia) in a patient with schizophrenia.
• Discontinuation of clozapine resulted in the recovery of hemoglobin levels.
• The exact pathogenesis remains unclear, with potential mechanisms including direct toxicity or drug-antibody complex formation.

Implications:

• This case underscores the need for vigilant monitoring of hemoglobin levels in patients treated with clozapine.
• It highlights pure red cell aplasia as a potential, albeit rare, adverse effect of clozapine.
• Further research is warranted to elucidate the mechanisms behind clozapine-induced hematological abnormalities.