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Blut

, Volume 61, Issue 4, pp 240–244 | Cite as

Transient pancytopenia

A report from the International Agranulocytosis and Aplastic Study
  • M. Keisu
  • W. Heit
  • G. Lambertenghi-Deliliers
  • J. Parcells-Kelly
  • A. Polliack
  • H. Heimpel
Original article

Summary

From a population-based study on the incidence of potentially drug-associated blood dyscrasias 28 cases were identified with pancytopenia. Who recovered within 90 days after diagnosis. Early recovery occured more frequently in patients showing normal or increased cellularity of the bone marrow than in patients with bone marrow hypoplasia. Median recovery times of leukocytes were 14 and 10 days and of platelets 21 and 9 days in patients with and without bone marrow hypoplasia, respectively. Age and sex distribution were similar in both groups. Of 28 patients, 11 reported a period of fever before onset of pancytopenia. Sixteen patients in whom information on drug use was available had taken a median of 4 drugs before the onset of symptoms that were related to pancytopenia. From these results we present the hypothesis that transient pancytopenia with or without marrow hypoplasia can be the expression of the same type of bone marrow injury and that drugs or viral infections should be considered as etiological factors.

Key words

Aplastic anemia Pancytopenia Agranulocytosis Drug induced blood dyscrasia 

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References

  1. 1.
    Barzel US (1967) Quinidine-sulfate-induced hypoplastic anemia and agranulocytosis. JAMA 201: 325–327PubMedGoogle Scholar
  2. 2.
    Bernard J, Schaison G (1987) Transitory bone marrow failure. Am J Pediatr Hematol Oncol 2: 141–144Google Scholar
  3. 3.
    Clausen N (1986) A population study of severe aplastic anemia in children. Incidence, etiology and course. Acta Paediatr Scand 75: 58–63PubMedGoogle Scholar
  4. 4.
    Dhingra K, Michels SD, Winton EF, Gordon DS (1988) Transient bone marrow aplasia associated with non-A, non-B hepatitis. Am J Hematol 29: 168–171PubMedGoogle Scholar
  5. 5.
    Frickhofen N, Raghavachar A, Heit W, Heimpel H (1986) Human parvovirus as a cause of transient pancytopenia. N Engl J Med 314: 646Google Scholar
  6. 6.
    Gouffier E, Schnurmann D, Durepaire H, Vernant JB (1978) Transient marrow aplasia during cimetidine treatment [letter]. Nouv Presse Med 7: 2660–2660Google Scholar
  7. 7.
    Heimpel H (1979) Laboratory aspects of aplastic anemia. In: Geary CG (ed) Aplastic anemia. Balliere Tindall, London, pp 63–81Google Scholar
  8. 8.
    Heimpel H (1988) Drug-induced agranulocytosis. Med Toxicol 3: 449–462Google Scholar
  9. 9.
    Heit W, Heimpel H, Fischer A, Frickhofen N (1985) Druginduced agranulocytosis: Evidence for the commitment of bone marrow haematopoiesis. Scand J Haematol 35: 459–468PubMedGoogle Scholar
  10. 10.
    Idänpään Heikkilä J, Alhava E, Olkinuora M, Palva IP (1977) Agranulocytosis during treatment with clozapine. Eur J Clin Pharmacol 11: 193–198PubMedGoogle Scholar
  11. 11.
    Israeli A, Or R, Leitersdorf E (1985) Captopril — associated transient aplastic anemia. Acta Haematol (Basel) 73: 106–107Google Scholar
  12. 12.
    Kornberg A, Rachmilewitz EA (1982) Aplastic anemia after prolonged ingestion of indomethacin. Acta Haematol (Basel) 67: 136–138Google Scholar
  13. 13.
    Leen C, Gibb AP, Brettle RP, Welsby PD (1982) Transient neutropenia and thrombocytopenia due to benoxaprofen [letter]. Lancet I: 1302–1302Google Scholar
  14. 14.
    Lima J, Biosca M, Ribera A, Garcia Bragado F (1986) Immune neutropenia and thrombopenia in infectious mononucleosis [letter]. Med Clin (Barc) 86: 481–481Google Scholar
  15. 15.
    McLaren GD, Doukas MA, Muir WA (1978) Methypryloninduced bone marrow suppression in siblings. An inherited defect? JAMA 240: 1744–1745PubMedGoogle Scholar
  16. 16.
    Mir MA, Geary CG (1980) Aplastic anemia: an analysis of 174 patients. Postgrad Med J 56: 322–326PubMedGoogle Scholar
  17. 17.
    Moreb J, Shemesh O, Shilo S, Manor C, Hershko C (1983) Transient methimazole-induced bone marrow aplasia: in vitro evidence for a humoral mechanism of bone marrow suppression. Acta Haematol (Basel) 69: 127–131Google Scholar
  18. 18.
    Neftel KA, Hauser SP, Muller MR (1985) Inhibition of granulopoiesis in vivo and in vitro by beta-lactam antibiotics. J Infect Dis 152: 90–98PubMedGoogle Scholar
  19. 19.
    Neftel KA, Walti M, Spengler H, von Felten A, Weitzman SA, Burgi H, de Weck AL (1981) Neutropenia after penicillins: toxic or immune-mediated? Klin Wochenschr 59: 877–888PubMedGoogle Scholar
  20. 20.
    Picozzi VJ, Swanson GF, Morgan R, Hecht F, Greenberg PL (1986) 13-cis-retinoic acid treatment for myelodysplastic syndromes. J Clin Oncol 4: 589–595PubMedGoogle Scholar
  21. 21.
    Pisciotta AV (1973) Immune and toxic mechanisms in drug induced cytopenias. Semin Hematol 10: 279–310PubMedGoogle Scholar
  22. 22.
    Rothman IK, Amorosi EL (1979) Procainamide-induced agranulocytosis and thrombocytopenia. Arch Intern Med 139: 246–247PubMedGoogle Scholar
  23. 23.
    Ruvidic R, Jelic S (1972) Haematological aspects of drug-in-duced agranulocytosis. Scand J Haematol 9: 18–27PubMedGoogle Scholar
  24. 24.
    Schmid L, Heit W, Flury R (1984) Agranulocytosis associated with semisynthetic penicillins and cephalosporins. Report of 7 cases. Blut 48: 11–18PubMedGoogle Scholar
  25. 25.
    Seip M (1983) Aplastic anemia during ethosuximide medication. Treatment with bolus-methylprednisolone. Acta Paediatr Scand 72: 927–929PubMedGoogle Scholar
  26. 26.
    Strair RK, Mitch WE, Faller DV, Skorecki KL (1985) Reversible captopril-associated bone marrow aplasia [letter]. Can Med Assoc J 132: 320–322Google Scholar
  27. 27.
    The international agranulocytosis and aplastic anemia study (1983) The design of a study of the drug etiology of agranulocytosis and aplastic anemia. Eur J Clin Pharmacol 24: 833–836Google Scholar
  28. 28.
    The international agranulocytosis and aplastic anemia study (1986) Risks of agranulocytosis and aplastic anemia — a first report of their relation to drug use with special reference to analgesics. JAMA 256: 1749–1757Google Scholar
  29. 29.
    The international agranulocytosis and aplastic anemia study (1987) Incidence of aplastic anemia: The relevance of diagnostic criteria. Blood 70: 1718–1821Google Scholar
  30. 30.
    The international agranulocytosis and aplastic anemia study (1988) Risk of agranulocytosis and aplastic anemia in relation to antithyroid drug use. Br Med J [Clin Res] 297: 262–265Google Scholar
  31. 31.
    The international agranulocytosis and aplastic anemia study (1989) Anti-infective drug use in relation to the risk of agranulocytosis and aplastic anemia. A report from the International Agranulocytosis and Aplastic Anemia Study. Arch Intern Med 149: 1036–1040Google Scholar
  32. 32.
    Vincent PC (1986) Drug-induced aplastic anemia and agranulocytosis. Incidence and mechanisms. Drugs 31: 52–63PubMedGoogle Scholar
  33. 33.
    Wickramasinghe SN (1975) Human bone marrow. Blackwell, Oxford London Edinburgh MelbourneGoogle Scholar
  34. 34.
    Young GAR, Vincent PC (1980) Drug-induced agranulocytosis. Clin Haematol 9: 483–504PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • M. Keisu
    • 1
  • W. Heit
    • 2
  • G. Lambertenghi-Deliliers
    • 3
  • J. Parcells-Kelly
    • 4
  • A. Polliack
    • 5
  • H. Heimpel
    • 2
  1. 1.Department of Clinical PharmacologyHuddinge University HospitalSweden
  2. 2.Abteilung für Innere Medizin IIIUniversity of UlmUlmFederal Republic of Germany
  3. 3.Policlinica Medica dell' UniversitàMilanoItaly
  4. 4.Slone Epidemiology UnitBoston UniversityBostonUSA
  5. 5.Lymphoma-Leukemia UnitHadassah University HospitalJerusalemIsrael

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