Hsiao Shu-Hwa, Lin Yih-Jyh, Hsu May-Ying, Wu Ta-Jen
Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
Kaohsiung J Med Sci. 2003 Nov;19(11):574-8. doi: 10.1016/S1607-551X(09)70509-1.
A 43-year-old woman with liver cirrhosis and hepatocellular carcinoma was admitted for the chief problem of ascites. Laboratory data revealed a leukocyte count of 3.8 x 10(9)/L on the second day of admission. Spironolactone was prescribed for diuresis beginning on the third day. Routine blood tests on the tenth day disclosed marked leukopenia (1.8 x 10(9)/L). Four days later, the leukocyte count was still 1.8 x 10(9)/L and a differential count revealed agranulocytosis (neutrophils, 0.25 x 10(9)/L). Eight days after withdrawal of spironolactone, the leukocyte count returned to normal (leukocytes, 4.9 x 109/L; neutrophils, 1.76 x 10(9)/L). On review of the patient's clinical condition, concurrent medication, and previous reports, we highly suspected that this episode of agranulocytosis was caused by spironolactone. Unlike four previously reported cases, this one did not involve furosemide, which is reported to be associated with leukopenia and agranulocytosis.
一名患有肝硬化和肝细胞癌的43岁女性因腹水这一主要问题入院。入院第二天实验室数据显示白细胞计数为3.8×10⁹/L。从第三天开始使用螺内酯进行利尿治疗。第十天的常规血液检查发现明显的白细胞减少（1.8×10⁹/L）。四天后，白细胞计数仍为1.8×10⁹/L，分类计数显示粒细胞缺乏症（中性粒细胞，0.25×10⁹/L）。停用螺内酯八天后，白细胞计数恢复正常（白细胞，4.9×10⁹/L；中性粒细胞，1.76×10⁹/L）。回顾患者的临床状况、同时服用的药物以及既往报告，我们高度怀疑这例粒细胞缺乏症是由螺内酯引起的。与之前报道的4例病例不同，该病例未涉及据报道与白细胞减少和粒细胞缺乏症有关的呋塞米。
