[Drug induced agranulocytosis. Improved prognosis due to better supportive care]

A retrospective study of 61 episodes of agranulocytosis observed in 56 patients between 1958 and 1977 is reported. The diagnosis was based on peripheral granulocyte counts below 500/mm3 and further documented by bone marrow analysis. The aim of this study was to determine whether the new guidelines for supportive care introduced in January 1973 led to an improvement in overall prognosis in this disease. Therefore, the patients were divided into two groups: the first group included 39 episodes of agranulocytosis observed between 1958-1972 and the second group 22 episodes observed between 1973-1977. Standard supportive care administered in the latter group included reverse isolation (hand-disinfection and gown-change before patient contact, conventional hospital single room), the immediate initiation of an appropriate combination of antibiotics in infectious states and additional granulocyte transfusions in selected cases. The two groups compared were similar as to the extent of neutropenia and the frequency of severe infectious complications. On the other hand, patients of the first group showed more advanced recovery of myelopoiesis as compared to the second group at the time of hospital admission. Death due to infection was observed in 36% of episodes in the first group, but only in 9% in the second group. The supportive care introduced in 1973 thus appears to improve the prognosis of agranulocytosis to a substantial extent.