Cheng Adrian, Buten Sara, Large Matthew
Department of Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia; and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
Department of Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia.
Australas Psychiatry. 2024 Aug;32(4):342-345. doi: 10.1177/10398562241258764. Epub 2024 May 31.
This paper critiques the haematological monitoring guidelines for clozapine. It describes the history of clozapine, as well as the pathophysiology and epidemiology of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA). The paper appraises the extant literature on mandatory clozapine haematological monitoring.
Contemporary Australian protocols for clozapine haematological monitoring are not consistent with the current evidence base. CIN and CIA are rare occurrences, and the associated risk of death is low. Potential modifications to existing guidelines include changing neutrophil thresholds for patients with benign ethnic neutropenia and reducing the frequency or removing haematological monitoring after two years of clozapine treatment.
本文对氯氮平的血液学监测指南进行了批判。它描述了氯氮平的历史，以及氯氮平诱导的中性粒细胞减少症（CIN）和粒细胞缺乏症（CIA）的病理生理学和流行病学。本文评估了关于氯氮平强制性血液学监测的现有文献。
当代澳大利亚氯氮平血液学监测方案与当前的证据基础不一致。CIN和CIA很少发生，且相关死亡风险较低。对现有指南的潜在修改包括改变良性种族性中性粒细胞减少症患者的中性粒细胞阈值，以及在氯氮平治疗两年后减少血液学监测的频率或取消监测。
