Medical Care: Care is based on the etiology of the agranulocytosis. In most cases in which drug exposure is involved, the most important step is to discontinue the offending agent. If the identity of the causative agent is not known, stop administration of all drugs until the etiology is established.
" Start specific antibiotic therapy to combat infections. This often involves the use of third-generation cephalosporins or equivalents.
" Treat areas of stomatitis and skin infections with local cleaning, antisepsis, and dental care. These infections should be managed by someone who has experience in the treatment of infections in neutropenic patients.
" Control oral and gingival lesion pain with saline and hydrogen peroxide rinses and local anesthetic gels and gargles.
" The availability of the recombinant neutrophil cytokine, filgrastim (ie, G-CSF), has altered the management of agranulocytosis.
o When administered before infection is established, filgrastim shortens the period to recovery and the duration of infection.
o The agent is especially indicated in the management of congenital neutropenia, idiopathic severe chronic neutropenia, and cyclic neutropenia when serious infections are involved.
o If the condition is mild, with only neutropenia without a serious infection, filgrastim may be withheld.
" Granulocyte transfusions have undergone a cycle of popularity followed by disfavor, though they may be useful in patients with life-threatening infections whose conditions are not responding to antibiotics.
o These transfusions are accompanied by many complications, including severe febrile reactions.
o The use of granulocyte transfusions remains controversial.
" In cases caused by heavy metals such as gold, chelation with British antilewisite (dimercaprol) may be needed.
Surgical Care:
" Surgical care is generally not indicated.
" Systemic lupus associated with autoimmune agranulocytosis may respond to splenectomy.
" Splenectomy has also been used in Felty syndrome, but the response is often short lived.
Diet:
" All foods must be thoroughly cooked. Raw fruits and vegetables may contain large numbers of bacteria and should be avoided.
" In patients with periodontitis and stomatitis, a soft or full liquid diet is indicated. Spicy and acidic foods should be avoided until recovery is complete.
Activity: Patient activity is permitted as tolerated.