Nielsen H
Department of Infectious Diseases, Hvidovre University Hospital, Denmark.
J Intern Med. 1993 Nov;234(5):529-31. doi: 10.1111/j.1365-2796.1993.tb00789.x.
After 10 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 33-year-old female. The patient was treated with filgrastim (granulocyte colony-stimulating factor [G-CSF]) 5 micrograms kg-1 day-1. The neutrophil count was 0.234 x 10(9) l-1 on admission, with a further decrease the next day to < 0.050 x 10(9) l-1, and this complete agranulocytosis continued for 10 days. As no response was obtained after 1 week the dosage of filgrastim was increased to 10 micrograms kg-1 day-1 with immediate improvement. A rapid and pronounced leucocytosis developed with maximal value of neutrophil granulocytes (including immature forms) of 33.108 x 10(9) l-1 on day 12 after admission. The patient only had minor infectious complications during the neutropenic period. In conclusion, early treatment with filgrastim seems warranted in severe cases of clozapine-induced agranulocytosis. A dosage of 10 micrograms kg-1 day-1 can be recommended.
在使用氯氮平治疗10周后，一名33岁女性被诊断为严重粒细胞缺乏症。患者接受了非格司亭（粒细胞集落刺激因子[G-CSF]）治疗，剂量为5微克/千克/天。入院时中性粒细胞计数为0.234×10⁹/升，次日进一步降至<0.050×10⁹/升，这种完全性粒细胞缺乏持续了10天。1周后未获反应，于是将非格司亭剂量增至10微克/千克/天，随即病情改善。出现了快速且显著的白细胞增多，入院后第12天中性粒细胞（包括未成熟形式）的最大值达到33.108×10⁹/升。患者在中性粒细胞减少期仅出现轻微感染并发症。总之，对于氯氮平所致严重粒细胞缺乏症的病例，早期使用非格司亭治疗似乎是必要的。可推荐剂量为10微克/千克/天。
