15262 Agranulocytosis

Overview

Agranulocytosis is a rare but serious condition in which your body has a very low level of a type of white blood cell called granulocytes. These cells are important for fighting off bacterial infections. Without enough of them, you are at much higher risk of getting serious infections.

It is rare. Most cases happen as a side effect of certain medicines, but it can also be caused by infections or other medical conditions.

It can affect people of any age, but it is more common in people taking certain medicines, such as some treatments for cancer, thyroid disease, or mental health conditions.

Symptoms

Common symptoms

• Sudden fever or chills
• Sore throat or painful swallowing
• Mouth sores or ulcers
• Weakness or tiredness
• Feeling generally unwell

Symptoms in children

• Fever
• Irritability or unusual tiredness
• Poor feeding or refusing to eat
• Sores inside the mouth

Symptoms in older adults

• Confusion or being less alert
• Lethargy and weakness
• Fever, sometimes without other symptoms
• Breathing problems or fast heartbeat

Causes

Main causes

• Certain medicines that reduce bone marrow function, such as some antibiotics, anticancer drugs, anti-thyroid medicines, or anti-inflammatory medicines
• Viral or bacterial infections
• Autoimmune conditions, where the immune system attacks its own cells
• Bone marrow disorders or damage

Risk factors

• Taking medicines linked to agranulocytosis
• Having previously had a serious reaction to a medicine
• Being older and taking multiple medicines
• Having a weakened immune system

When to see a doctor

See a doctor urgently if:

• If you have fever, chills, throat pain, or any signs of infection and you are taking a medicine that can cause agranulocytosis, seek medical advice the same day.

Book a routine appointment if:

• If you have unexplained tiredness, repeated infections, or mouth sores, ask for a blood test.

Diagnosis

Your doctor will ask about your symptoms and any medicines you take. They will order a blood test to check your white blood cell levels, including the specific cells called granulocytes.

Tests that may be done

• Complete blood count (CBC)
• White blood cell differential to measure different types of white blood cells
• Sometimes a bone marrow test if the cause is not clear

What to expect at your appointment

The blood test is quick and simple. If the results show very low granulocytes, you may be referred to a blood specialist (hematologist). Your doctor may also ask you to stop or change a medicine you are taking.

Treatment

Treatment depends on the cause and how severe it is. The main goals are to help your bone marrow recover, prevent infections, and treat any infections quickly. If a medicine is the cause, your doctor may stop or change it. In serious cases, you may need to stay in hospital.

Self-care at home

• Wash your hands often with soap and water.
• Stay away from people who are sick or who have recently had vaccines.
• Take your temperature regularly and report any fever to your healthcare team.
• Avoid cuts and scrapes. Clean any minor wounds with antiseptic and cover them.
• Do not share food, drinks, or personal items.

Medical treatments

Your doctor may give you medicines called growth factors to help your bone marrow make more white blood cells. Antibiotics or antifungal medicines may be used to prevent or treat infections. In hospital, you may be placed in a separate room to reduce your exposure to germs.

When is surgery considered?

Surgery is not a treatment for agranulocytosis itself. However, if an infection causes a collection of pus (abscess), a small procedure may be needed to drain it.

Living with this condition

While you are ill, you will need regular blood tests and likely close support from your medical team. Most people recover once the cause is treated, but it can take time. Be patient with your body and focus on rest.

Lifestyle tips

• Avoid crowded indoor places when possible.
• Wear a face mask in healthcare settings.
• Maintain good personal hygiene, including brushing your teeth gently with a soft toothbrush.
• Get plenty of sleep and reduce stress where you can.

Diet and exercise

Eat a balanced diet to help your body recover. Avoid raw or undercooked meat, fish, eggs, and unpasteurised dairy products, because these can carry bacteria. Gentle exercise, like short walks, is fine if you feel well, but rest when you are tired.

Mental health and emotional wellbeing

Dealing with a serious blood condition can be frightening and stressful. It is normal to feel anxious or low. Talk to your care team about how you are feeling - they can offer support and may refer you to a counsellor.

Prevention

You cannot always prevent agranulocytosis, especially if it is a reaction to a medicine you need. If you have had it before, you should tell your doctor and avoid the medicine that caused it.

Vaccines

Keep your routine vaccinations up to date, like the flu vaccine, but always ask your doctor first. Some vaccines are not suitable for people with very weak immune systems.

Screening programmes

If you are taking a medicine linked to agranulocytosis, your doctor may check your blood counts regularly to catch a problem early.

Complications

If left untreated

• Serious, life-threatening infections such as pneumonia or blood poisoning (sepsis)
• Infections that spread quickly through the body
• Delayed recovery or long-term bone marrow damage in rare cases

Long-term outlook

With early treatment, most people recover fully. If a medicine caused the condition, stopping it often leads to improvement within weeks. Your medical team will guide you and watch your progress closely, so there is good reason for hope.

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