Agranulocytosis

Agranulocytosis is a condition in which the bone marrow produces too few granulocytes, a type of white blood cell that fights infection. Agranulocytosis must be treated immediately because it can cause serious complications, even life-threatening.

Granulocytes are a group of white blood cells consisting of neutrophils, eosinophils , and basophils. In agranulocytosis, the bone marrow is unable to produce certain white blood cells in sufficient quantities. The type of white blood cell that is low in number is usually neutrophils.

Under normal circumstances, bone marrow is able to produce 1,500 neutrophils per microliter of blood. While in agranulocytosis, the number of neutrophils formed is less than 100 per microliter of blood. In conditions like this, the body will be more susceptible to severe infections, even if the germs that infect are not dangerous.

Causes of Agranulocytosis

Agranulocytosis can occur due to genetic disorders inherited from parents. Agranulocytosis that has appeared since birth (congenital) is also called Kostmann syndrome .

In addition to genetic disorders, agranulocytosis can also be caused by certain conditions or diseases. The following are conditions or diseases that can cause agranulocytosis: 

• Autoimmune diseases, such as lupus and rheumatoid arthritis
• Disorders of the bone marrow, such as aplastic anemia, leukemia, and myelodysplastic syndrome
• Viral infections, such as hepatitis virus, HIV, and cytomegalovirus (CMV)
• Bacterial infections, such as typhoid fever and tuberculosis
• Parasitic infections, such as malaria
• Mercury or lead poisoning
• Side effects of medications, such as antipsychotic drugs, antibiotics, anti-inflammatories, chemotherapy for cancer, and drugs for hyperthyroidism

There are several types of drugs that can trigger agranulocytosis, such as metamizole . If in doubt, you can consult online to ask what drugs to avoid so that you do not get this condition.

Symptoms of Agranulocytosis

People with agranulocytosis will be susceptible to infection due to the small number of white blood cells in the body that are tasked with fighting attacks by disease-causing germs. In this condition, symptoms that can appear in people with agranulocytosis include:

• Fever and chills
• Weak
• Muscle weakness
• Sore throat 
• Frequent canker sores
• Toothache
• Rash
• Dizzy
• Bleeding gums
• Excessive sweating
• Bone pain
• Coughs and colds

When to see a doctor

See a doctor if you experience the above symptoms, especially if you have a condition that can cause agranulocytosis. A doctor’s examination is necessary immediately if you often have infections, especially those that are difficult to heal.

Diagnosis of Agranulocytosis

The doctor will first ask the patient questions about the following:

• Possible exposure to chemicals
• Symptoms that appear
• Other diseases ever suffered
• Medications currently being taken

If a patient is suspected of having agranulocytosis, the doctor will perform the following further examinations to confirm the diagnosis:

• Complete blood count, to check the overall number of blood cells, especially white blood cells.
• Absolute neutrophil count, a follow-up to a complete blood count, to count the number of each type of white blood cell.
• Bone marrow aspiration , to check the condition of the tissue that produces blood cells.
• Genetic testing, to confirm the possibility of a genetic disease causing agranulocytosis.

Agranulocytosis Treatment

Treatment for agranulocytosis will be adjusted to the cause. Some methods that can be done to overcome agranulocytosis are:

• Administration of antibiotics, antivirals, or antiparasitics, to treat agranulocytosis due to infection
• Injection of granulocyte colony-stimulating factor (G-CSF), such as filgrastim , to stimulate the bone marrow to produce granulocytes more quickly.
• Administration of immunosuppressants, to treat agranulocytosis due to autoimmune disease
• Bone marrow transplantation , so that the new bone marrow can produce white blood cells normally.

If agranulocytosis is caused by the use of certain drugs, the doctor will stop giving the drug, adjust the dose, or replace it with another drug.

Complications of Agranulocytosis

If not treated properly, agranulocytosis can lead to sepsis , an overreaction to infection that can cause blood pressure to drop drastically. This condition can cause damage to many organs and tissues in the body, and can even cause death.

Prevention of Agranulocytosis

Agranulocytosis is difficult to prevent, unless it is caused by the use of drugs that can be replaced. If agranulocytosis occurs due to chemotherapy drugs, the doctor may give the patient an injection of G-CSF, to increase the body’s ability to produce neutrophils.

It is important to prevent infection in agranulocytosis. If you have this disease, here are some ways you can reduce your risk of infection:

• Eating foods, such as meat, seafood, or eggs, that are thoroughly cooked
• Maintain cleanliness every time you store and prepare food, for example by washing your hands before touching food that will be cooked.
• Eat fruits or vegetables that have been washed or peeled thoroughly.
• Wash your hands regularly and maintain overall body hygiene
• Avoid close contact with people who are sick
• Limit work involving contact with soil and animals.
• Do not swim in rivers or public swimming pools

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Cleveland Clinic (2023). Agranulocytosis.
Verywell Health (2024). What is Agranulocytosis?
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