As a rule, any drug that promises miracles also quietly whispers, “I might kill your neutrophils.”
That whisper becomes a scream when you’re reviewing a CBC and the neutrophil count has packed up and left. 😑
Agranulocytosis is no joke — especially in our CCU, where immunocompromised patients walk a fine line between recovery and disaster. A while ago, we admitted a middle-aged woman from Mashkel, Balochistan, who had been on carbimazole for thyrotoxicosis. Fever, sore throat, WBC count of 1,000 — and a neutrophil count that needed a magnifying glass. 🧫
She looked at me and said, “Bas bukhar he hai.”
I looked at her labs and thought, No, this is bone marrow mutiny. 😬
🔥 Mnemonic: “8 C’s”
| Drug | Class / Use | Clinical Insight |
|---|---|---|
| Clozapine | Atypical antipsychotic | Requires mandatory weekly WBC/ANC monitoring — psychiatry’s double-edged sword. 🧠 |
| Colchicine | Gout management | Dose-dependent bone marrow suppression — especially in renal dysfunction. 🦶⚠️ |
| Carbamazepine | Anticonvulsant / Mood stabilizer | Watch CBC in first few months — especially in Asian patients with HLA-B*1502. ⛑️ |
| Chloramphenicol | Antibiotic (rarely used now) | Causes aplastic anemia + agranulocytosis. Still used in typhoid/meningitis in some areas. ⚔️ |
| Captopril | ACE inhibitor | Rare, but listed in literature — neutropenia mostly in patients with renal impairment. 💊 |
| Cephalosporins | Beta-lactam antibiotics | High-dose, prolonged use = risk of neutropenia. Seen more in ICU settings. 🧫 |
| Carbimazole | Antithyroid drug | Famous for sudden agranulocytosis — patients usually present with fever/sore throat. 🌡️ |
| Cimetidine | H2 receptor blocker | Uncommon, but case reports exist. Makes you question even your antacids. 🧪 |
🏥 Ward Wisdom from Sheikh Khalifa Bin Zayed Hospital, Quetta
Last year, Dr. Danish Ramzan referred a cirrhotic patient from Awaran who developed fever after being treated with colchicine for peritoneal inflammation.
The neutrophil count? <500.
Dr. Basit Khan peeked at the file and said, “Colchicine giveth pain relief and taketh away the neutrophils.” 💀
Alright folks! That’s it for today… we hope that you find this blog post useful in your studies/clinical practice. 🙂
👨⚕️ Authored by:
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
