Schmid L, Heit W, Flury R
Blut. 1984 Jan;48(1):11-8. doi: 10.1007/BF00320712.
Within one year we observed in the same intensive care unit seven severely polytraumatized patients with agranulocytosis (AG) associated with treatment by semisynthetic penicillins or cephalosporins combined with aminoglycosides. Antibiotics were given because of severe bacterial respiratory or generalised infections. Five patients died, four of them without haematological remission. Bone marrow aspirates showed hypoplasia of granulopoiesis due to a lack of mature cells. Leukocyte and granulocyte counts in the blood declined continuously over a period of 8 to 11 days. In average, minimal granulocyte counts occurred after 21 days of hospitalisation and 14 days of antibiotic drug exposure. Beside the incriminated antibiotics all patients were treated sporadically with other agents of which may cause AG. Granulocyte kinetics and serial bone marrow examinations of one patient suggest a phenothiazine type of AG, which is caused by a toxic damage of granulopoiesis. Declining absolute granulocyte counts in the blood together with persisting high temperatures during antibiotic treatment should give rise to the suspicion of a beginning AG.
在一年时间里，我们在同一重症监护病房观察到7例严重多发伤患者出现粒细胞缺乏症（AG），这些患者接受了半合成青霉素或头孢菌素联合氨基糖苷类药物的治疗。使用抗生素是因为患者发生了严重的细菌性呼吸道感染或全身性感染。5例患者死亡，其中4例未出现血液学缓解。骨髓穿刺显示由于缺乏成熟细胞，粒细胞生成减少。血液中的白细胞和粒细胞计数在8至11天内持续下降。平均而言，粒细胞计数最低值出现在住院21天和接触抗生素药物14天后。除了上述有嫌疑的抗生素外，所有患者还偶尔接受过其他可能导致AG的药物治疗。对1例患者的粒细胞动力学和系列骨髓检查提示为吩噻嗪型AG，是由粒细胞生成的毒性损伤所致。抗生素治疗期间血液中绝对粒细胞计数下降以及持续高热应引起对AG开始发生的怀疑。
