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[Agranulocytosis caused by metamizol. Anesthetic attitude]
M P Prieto Alvarez1, J G Fuentes Bellido, J López Cebollada
1Servicio de Anestesiología, Reanimación y Clínica del Dolor, Pius Hospital de Valls, Tarragona.
Abstract:
Agranulocytosis induced by metamizole is uncommon, with a frequency of less than one case per million treatments. We describe such a case in a patient requiring emergency surgery. An 85-year-old man with a history of infantile paralysis with mental retardation and Paget's disease and X-ray signs of the right femur came to the emergency room with a diaphysial fracture. He received 1 g metamizole i.v. every 8 hours for analgesia. Ten hours after admission a routine blood cell count showed a rapid fall in the number of leukocytes; at 24 hours the count was 600 x 10(9)/l. The diagnosis was agranulocytosis induced by metamizole. Postponement of surgery was advisable and treatment with granulocyte colony stimulating factor (GCSF) at a dose of 5 micrograms/kg/day. Agranulocytosis resolved after 3 days of treatment, after which time the bone was set with a straight femoral plate under subarachnoid anesthesia. Two packs of red blood cells were required during the immediate postoperative period. Twelve days after surgery the patient was released. We review the anesthetic approach to agranulocytosis and its treatment.
Insights
Metamizole-induced agranulocytosis is rare but serious. This case highlights prompt diagnosis and granulocyte colony-stimulating factor (G-CSF) treatment for recovery before emergency surgery.
Area of Science:
- Pharmacology
- Hematology
- Anesthesiology
Background:
- Metamizole is an uncommon cause of agranulocytosis, occurring in less than one per million treatments.
- Agranulocytosis is a severe adverse drug reaction characterized by a significant reduction in neutrophils.
Observation:
- An 85-year-old male patient developed agranulocytosis after receiving intravenous metamizole for analgesia.
- Leukocyte count rapidly decreased to 600 x 10(9)/l within 24 hours of metamizole administration.
Findings:
- The patient's agranulocytosis was successfully treated with granulocyte colony-stimulating factor (G-CSF).
- Surgical intervention for a femoral fracture was postponed until the patient's neutrophil count normalized.
Implications:
- This case underscores the importance of recognizing and managing metamizole-induced agranulocytosis, especially in surgical patients.
- Prompt G-CSF treatment can facilitate recovery and allow for timely surgical procedures in patients with drug-induced agranulocytosis.