J Korean Neuropsychiatr Assoc.  2015 May;54(2):252-256. 10.4306/jknpa.2015.54.2.252.

A Case of Clozapine-Induced Anemia and Thrombocytosis

Affiliations
  • 1Department of Psychiatry, Seoul National University Hospital, Seoul, Korea.
  • 2Department of Psychiatry, St. Andrews Neuropsychiatric Hospital, Icheon, Korea. hansonpark@snu.ac.kr
  • 3Department of Anthropology, College of Social Science, Seoul National University, Seoul, Korea.

Abstract

Clozapine is a well-known antipsychotic which causes hematologic adverse effects, specifically neutropenia and agranulocytosis (1-3% of patients). However, reports on blood dyscrasias like anemia and thrombocytosis after clozapine treatment are extremely rare. In some cases re-challenge of clozapine could lead to hematopoietic abnormality related to thrombocytopenia or thrombocytosis, which may be a result of an immune reaction. This case report suggests that clinicians should monitor platelet count after re-treatment with clozapine.

Keyword

Clozapine; Anemia; Thrombocytosis; Blood dyscrasia

MeSH Terms

Agranulocytosis
Anemia*
Clozapine
Neutropenia
Platelet Count
Thrombocytopenia
Thrombocytosis*
Clozapine

Figure

  • Fig. 1 Hematologic changes during the clozapine re-challenge period.


Reference

1. Baldessarini RJ, Frankenburg FR. Clozapine. A novel antipsychotic agent. N Engl J Med. 1991; 324:746–754.
2. Lieberman JA, Saltz BL, Johns CA, Pollack S, Borenstein M, Kane J. The effects of clozapine on tardive dyskinesia. Br J Psychiatry. 1991; 158:503–510.
Article
3. Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, et al. Clozapine treatment for suicidality in schizophrenia: international Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003; 60:82–91.
Article
4. Kant R, Chalansani R, Chengappa KN, Dieringer MF. The off-label use of clozapine in adolescents with bipolar disorder, intermittent explosive disorder, or posttraumatic stress disorder. J Child Adolesc Psychopharmacol. 2004; 14:57–63.
Article
5. Weiss E, Hummer M, Koller D, Pharmd , Ulmer H, Fleischhacker WW. Off-label use of antipsychotic drugs. J Clin Psychopharmacol. 2000; 20:695–698.
Article
6. The Parkinson Study Group. Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. . N Engl J Med. 1999; 340:757–763.
7. Hummer M, Kurz M, Barnas C, Saria A, Fleischhacker WW. Clozapine-induced transient white blood count disorders. J Clin Psychiatry. 1994; 55:429–432.
8. Buchanan RW. Clozapine: efficacy and safety. Schizophr Bull. 1995; 21:579–591.
Article
9. Durst R, Dorevitch A, Fraenkel Y. Platelet dysfunction associated with clozapine therapy. South Med J. 1993; 86:1170–1172.
Article
10. Young CR, Bowers MB Jr, Mazure CM. Management of the adverse effects of clozapine. Schizophr Bull. 1998; 24:381–390.
Article
11. Gareri P, De Fazio P, Russo E, Marigliano N, De Fazio S, De Sarro G. The safety of clozapine in the elderly. Expert Opin Drug Saf. 2008; 7:525–538.
Article
12. Savithasri Eranti V, Chaturvedi SK. Maked thrombocyte count variations without agranuloctosis due to clozapine. Indian J Psychiatry. 1998; 40:300–302.
13. Papadakis M, McPhee SJ, Rabow MW. Current medical diagnosis & treatment 2014. New York: McGraw-Hill Education;2014.
14. Harrison CN, Campbell PJ, Buck G, Wheatley K, East CL, Bareford D, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005; 353:33–45.
Article
15. Thorup M, Fog R. Clozapine treatment of schizophrenic patients. Plasma concentration and coagulation factors. Acta Psychiatr Scand. 1977; 55:123–126.
Article
16. Paciullo CA. Evaluating the association between clozapine and venous thromboembolism. Am J Health Syst Pharm. 2008; 65:1825–1829.
Article
17. Hampson ME. Clozapine-induced thrombocytosis. Br J Psychiatry. 2000; 176:400.
Article
18. Marlowe K. Thrombocytosis due to clozapine treatment: working towards an early marker for clozapine-induced agranulocytosis. Br J Psychiatry. 2000; 177:372–373.
Article
19. Kim YS, Ahn YM, Jung SH, Shin YM. Clinical use of clozapine: 89 questions and answers. Seoul: SNU press;2013. p. 143–144.
20. Alvir JM, Lieberman JA, Safferman AZ, Schwimmer JL, Schaaf JA. Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. N Engl J Med. 1993; 329:162–167.
Article
21. Arranz M, Collier D, Sodhi M, Ball D, Roberts G, Price J, et al. Association between clozapine response and allelic variation in 5-HT2A receptor gene. Lancet. 1995; 346:281–282.
Article
22. Dietrich-Muszalska A, Rabe-Jablonska J, Nowak P, Kontek B. The first- and second-generation antipsychotic drugs affect ADP-induced platelet aggregation. World J Biol Psychiatry. 2010; 11(2 Pt 2):268–275.
Article
23. Schedel A, Thornton S, Klüter H, Bugert P. The effect of psychoactive drugs on in vitro platelet function. Transfus Med Hemother. 2010; 37:293–298.
Article
24. Hägg S, Spigset O, Söderström TG. Association of venous thromboembolism and clozapine. Lancet. 2000; 355:1155–1156.
Article
25. Iqbal MM, Rahman A, Husain Z, Mahmud SZ, Ryan WG, Feldman JM. Clozapine: a clinical review of adverse effects and management. Ann Clin Psychiatry. 2003; 15:33–48.
Article
26. Arranz MJ, Munro J, Birkett J, Bolonna A, Mancama D, Sodhi M, et al. Pharmacogenetic prediction of clozapine response. Lancet. 2000; 355:1615–1616.
Article
27. Arranz MJ, de Leon J. Pharmacogenetics and pharmacogenomics of schizophrenia: a review of last decade of research. Mol Psychiatry. 2007; 12:707–747.
Article
28. Kim HC, Suh YL, Park YN, Chung CH, Kim JB. A case of leukocytosis and eosinophilia associated with clozapine. J Korean Soc Biol Ther Psychiatry. 1997; 3:259–264.
29. Cho MJ, Oh JT, Kang BJ, Lee Y. Clozapine-induced agranulocytosis and neutropenia for 11 years in South Korea. J Korean Soc Biol Ther Psychiatry. 2004; 10:184–191.
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