一名接受氯氮平和拉莫三嗪治疗的患者出现快速发作的粒细胞缺乏症。
Rapid-onset agranulocytosis in a patient treated with clozapine and lamotrigine.
作者信息
Urban Anna Emilia, Wiglusz Mariusz S, Cubała Wiesław Jerzy, Landowski Jerzy, Krysta Krzysztof
机构信息
Department of Psychiatry, Medical University of Gdańsk, Dębinki 7 St. build. 25, 80-952 Gdańsk, Poland.
出版信息
Psychiatr Danub. 2015 Sep;27 Suppl 1:S459-61.
BACKGROUND
Clozapine is the treatment of choice in drug-resistant schizophrenia. Lamotrigine is a mood stabiliser recommended as combined treatment strategy in clozapine-resistant patients. There are cases of late-onset agranulocytosis reported in literature. Some are associated with clozapine or lamotrigine, others with the combination of both.
CASE REPORT
The article presents a case of rapid-onset agranulocytosis in a 60-year old clozapine-resistant patient, in whom lamotrigine was introduced as potentiation strategy. Discontinuation of both substances and GCSF treatment resulted in normalization of the absolute neutrophil count.
CONCLUSIONS
The case suggests a possibility of developing rapid-onset agranulocytosis in clozapine-resistant patients who require lamotrigine as augmentation strategy. This emphasises the significance of monitoring a patient's blood count and early management of any dyscrasias noticed.
背景
氯氮平是耐药性精神分裂症的首选治疗药物。拉莫三嗪是一种心境稳定剂，被推荐作为氯氮平耐药患者的联合治疗策略。文献报道了迟发性粒细胞缺乏症的病例。有些与氯氮平或拉莫三嗪有关，其他的则与两者联合使用有关。
病例报告
本文介绍了一名60岁氯氮平耐药患者快速发生粒细胞缺乏症的病例，该患者引入拉莫三嗪作为增效策略。停用这两种药物并给予粒细胞集落刺激因子（GCSF）治疗后，绝对中性粒细胞计数恢复正常。
结论
该病例提示，对于需要拉莫三嗪作为增效策略的氯氮平耐药患者，有可能发生快速粒细胞缺乏症。这强调了监测患者血细胞计数以及对任何发现的血液异常进行早期处理的重要性。
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