Stip Emmanuel, Langlois Robert, Thuot Claude, Mancini-Marïe Adham
Department of Medicine and Psychiatry, Hôpital Louis-H. Lafontaine, University of Montreal, Montreal, Canada.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):297-300. doi: 10.1016/j.pnpbp.2006.08.005. Epub 2006 Sep 15.
Neutropenia and agranulocytosis are risks known to occur with phenothiazines and clozapine. The mechanisms responsible for these conditions currently remain unclear. To our knowledge, no case of fatal agranulocytosis as a result of olanzapine treatment was reported in the literature. Thus any case of severe neutropenia occurring in a patient receiving olanzapine is alarming to clinicians. First, a review of the literature produced 41 anecdotic cases of neutropenia or agranulocytosis during treatment with olanzapine (Zyprexa) reported in a total of 24 publications. Second, we report a case of neutropenia, which proved to be fatal in a schizophrenia patient receiving olanzapine and thiazide. The cause of the death was Myelodysplastic syndrome. There is not enough evidence to prove the involvement of either olanzapine or hydrochlorothiazide or the interaction between them in this patient's myelodysplasia. Bone marrow cytogenetic study confirmed the deletion of the long arm of chromosome 11, as reported in myeloid leukemia. If this patient would have died suddenly without the laboratory investigations that lead to the diagnosis of myeloblastic leukemia, the cause would have been probably and wrongfully allotted to treatment with olanzapine.
中性粒细胞减少症和粒细胞缺乏症是已知与吩噻嗪类药物和氯氮平相关的风险。目前，导致这些情况的机制仍不清楚。据我们所知，文献中未报道过因奥氮平治疗导致致命性粒细胞缺乏症的病例。因此，接受奥氮平治疗的患者出现任何严重中性粒细胞减少症的病例都会引起临床医生的警觉。首先，查阅文献发现，共有24篇出版物报道了41例奥氮平（再普乐）治疗期间出现中性粒细胞减少症或粒细胞缺乏症的轶事性病例。其次，我们报告了一例中性粒细胞减少症病例，该病例在一名同时接受奥氮平和噻嗪类药物治疗的精神分裂症患者中被证明是致命的。死亡原因是骨髓增生异常综合征。没有足够的证据证明该患者骨髓发育异常与奥氮平、氢氯噻嗪或它们之间的相互作用有关。骨髓细胞遗传学研究证实了11号染色体长臂缺失，这在髓系白血病中也有报道。如果该患者没有进行导致诊断为髓母细胞白血病的实验室检查就突然死亡，那么死因可能会被错误地归咎于奥氮平治疗。
