What Is Agranulocytosis?

Agranulocytosis is the term used when the bone marrow fails to form granulocytes. Granulocytes, which are mostly composed of neutrophils, are a type of white blood cell that is responsible for fighting infections. The body that lacks granulocytes or neutrophils is susceptible to infection.

Under normal circumstances, bone marrow is able to form 1,500 neutrophils per microliter of blood. Whereas in agranulocytosis, the number of absolute neutrophils counted was not up to 100 neutrophils per microliter of blood. Under conditions of low neutrophil count, a mild infection can develop into a serious infection. Microbes or harmless germs can develop and become harmful to the body. Agranulocytosis is a fairly serious condition. If not treated promptly can result in sepsis and death.

Symptoms of Agranulocytosis
People who have agranulocytosis will be susceptible to infection because of the small number of white blood cells that are responsible for fighting bacterial attacks.

Symptoms that appear like infection, include:

• Fever .
• Limp.
• Headache.
• Chills and sweats.
• Redness around the face.
• Sore throat.
• Thrush that does not improve.
• Bleeding gums.
• An ulcer on the skin.

If severe infection can result in:

• Tachycardia .
• Breath becomes fast.
• Low blood pressure or hypotension.

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Causes Agranulocytosis
Agranulocytosis may be due to birth defects (congenital) or acquired by illness, medication, and medical procedures. Congenital agranulocytosis is caused by a rare genetic disorder, the Kostmann syndrome. This disorder is passed on to the children of the elderly.

One study proves that as many as 70 percent of cases of agranulocytosis are associated with the use of antipsychotic drugs (eg clozapine ), antimalarial, antiinflammatory, and antithyroid (eg carbimazole ).

The causes of agranulocytosis are:

• Autoimmune conditions, such as lupus and rheumatoid arthritis.
• Diseases that attack the bone marrow, such as aplastic anemia , leukemia, and myelodysplasia syndrome.
• Hepatitis.
• HIV.
• Chemotherapy and bone marrow transplant action.
• Exposure to chemical compounds, such as arsenic or mercury .
• Drugs, such as antipsychotic drugs, malaria drugs (eg quinine pills), NSAIDs , and hyperthyroid medications (eg thiamazole).

Diagnosis of Agranulocytosis
The doctor will check the patient's medical history and perform a physical examination. If agranulocytosis is suspected, the doctor will perform a complete blood cell count and an absolute neutrophil count examination to check the total blood count, especially the white blood cells.

Blood test results are used to confirm subsequent diagnostic action. Another examination aims to determine the causes of agranulocytosis such as examination of bone marrow aspiration and bone marrow biopsy, which is taken blood samples and tissue from the bones of the pelvic region. Bone marrow is one where the production of blood cells. If a genetic disease is suspected, the doctor may request a genetic examination.


Treatment of Agranulocytosis
Infections that occur in agranulocytosis are treated with antibiotics. Antibiotics prescribed by a doctor will be given based on the severity of the infection. Sometimes antibiotics have been given prior to infection, which aims to prevent infection. In treating agranulocytosis, it is important to know the cause of the agranulocytosis itself, so that it can be handled appropriately. For example, if suspected of malaria-induced agranulocytosis, a substitute for the drug will be given. If necessary, treatment may be suspended.

Some medications to be recommended that are tailored to the cause of agranulocytosis are:

• Granulocyte-colony stimulating factor (G-CSF). This is done by injecting hormones that stimulate the bone marrow to produce more granulocytes. G-CSF injections are usually given by injection under the skin (subcutaneously) in patients agranulocytosis due to chemotherapy drugs. An example of a G-CSF is filgrastim.
• Immunosuppressants . If agranulocytosis is caused by an autoimmune condition, ie the presence of an immune that attacks the body itself, it will be given a drug that can suppress the immune system. For example corticosteroids .
• Bone marrow transplant. In the case of agranulocytosis that can no longer be treated through ordinary medication, bone marrow transplantation may be an option. This method generally gives the best results for patients under 40 years old with other organ functions such as heart, kidney, and good heart. Bone marrow transplantation can be performed in leukemia patients.

Patients with agranulocytosis are advised not to be in a crowded situation to minimize the risk of infection. Patients are also advised to avoid foods potentially exposed to bacteria, such as fruits or vegetables that are not washed or cleanly peeled.

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