Instant therapy of acquired agranulocytosis and sepsis by recombinant granulocyte-macrophage colony-stimulating factor in a polytrauma patient

Non-chemotherapy drug-induced agranulocytosis

Acute agranulocytosis is a rare, potentially life-threatening condition, which is attributable to drugs in > 70% of cases. Agranulocytosis is characterised by a peripheral neutrophil count < 0.5 x 10(9)/l. It often manifests with a severe sore throat, but isolated fever, pneumonia or septicaemia are not uncommon. Agranulocytosis may be caused by many drugs. High-risk drugs include antithyroid drugs, clozapine, ticlopidine, sulfasalazine, dipyrone, trimethoprim/sulfamethoxazole, carbamazepine and probably rituximab. Suspect drugs should be stopped immediately. In febrile patients, blood cultures and, where indicated, site-specific cultures should be obtained and treatment with empirical broad spectrum antibiotics started. Haematopoietic growth factors should be considered in patients with poor prognostic factors (e.g., a neutrophil count < 0.1 x 10(9)/l), severe clinical infection or severe underlying disease or comorbidity. Case fatality has decreased to ~ 5% in recent years, probably owing to improved intensive care treatment and increased alertness of physicians to this severe adverse reaction.

Hematopoietic growth factors in clinical practice

OBJECTIVE

To review the hematopoietic growth factors (HGFs) as they relate to hematopoiesis, dosing, administration, toxicities and clinical indications.

DATA SOURCES

Research studies, abstracts, review articles, product package inserts, and book chapters pertaining to HGFs.

CONCLUSIONS

HGFs are essential components for the development of blood cells. Recombinant DNA technology and the availability of HGFs have significantly altered the care of patients with cancer and bone marrow disorders.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can play a major role in assisting patients, families, and various consumers by providing education about HGFs as well as their indications, schedule, methods of administration, and toxicities. Familiarity with the HGFs and the literature available can assist nurses in developing management strategies for patients receiving these agents.