losartan-potassium and Agranulocytosis

Topics: Agranulocytosis; Anemia; Erythropoietin; Granulocyte Colony-Stimulating Factor; Granulocyte-Macrophage Colony-Stimulating Factor; Hematopoietic Cell Growth Factors; Humans

Forty-eight patients with early myelodysplastic syndrome (MDS) without excess of blasts, with average initial serum ferritin levels of 2739.5 μg/L (range 825-11287 μg/L), were treated with deferiprone (L1) in a daily dose of 40-90 mg/kg. Median duration of chelation treatment was 10.9 months (range 4-24 months). Chelation was effective (maintained or decreased iron stores) in 16 out of 22 patients (73%) with serum ferritin levels <2000 μg/L in contrast to only 12 out of 26 patients with serum ferritin levels >2000 μg/L. Combination of L1 with recombinant human erythropoietin (rHuEPO) (30-40 kU/week) resulted in effective chelation in five additional patients with serum ferritin levels >3000 μg/L. Incidence of adverse effects was comparable to that in thalassemic patients. Gastrointestinal symptoms represented the most frequent adverse effect of L1 therapy (37.5% of patients) that limited an effective escalation of the daily dose of the drug and led to discontinuation of the treatment for six patients. A decreased number of granulocytes was observed in five (13%) patients and agranulocytosis occurred in two patients (4%). Granulocyte counts were restored after cessation of L1 treatment and administration of granulocyte colony stimulating factor (G-CSF) in all but one patient. Administration of L1 in a daily dose of at least 75 mg/kg may represent an alternative approach in treatment of mild and moderate iron overload in MDS patients who cannot be treated with deferasirox (DFRA) or deferoxamine (DFO).

Topics: Adult; Aged; Aged, 80 and over; Agranulocytosis; Deferiprone; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Erythropoietin; Female; Ferritins; Gastrointestinal Diseases; Granulocyte Colony-Stimulating Factor; Humans; Iron Chelating Agents; Iron Overload; Male; Middle Aged; Myelodysplastic Syndromes; Pyridones; Recombinant Proteins; Treatment Outcome

In a prospective, controlled trial 26 anaemic, neutropenic children with newly diagnosed acute lymphocytic leukaemia were randomised in pairs to receive either transfusion to a haemoglobin of 10--12 g/dl where clinically indicated (group A) or hypertransfusion to a haemoglobin of 16--18 g/dl (group B). Compared with group A (11 of 13 transfused), group B (all transfused) had a significantly more rapid rise in neutrophils at 7 and 10 days post-transfusion, a lower incidence of infection, and less interruption to chemotherapy. Hypertransfusion restored the myeloid/erythroid ratio to normal in bone-marrow of 5 of 6 children and the proportion of early myeloid precursors was greater than in controls.

Topics: Adolescent; Agranulocytosis; Blood Transfusion; Cell Count; Child; Child, Preschool; Clinical Trials as Topic; Erythropoietin; Female; Hematopoietic Stem Cells; Hemoglobins; Humans; Infant; Infection Control; Leukemia, Lymphoid; Leukocyte Count; Male; Neutropenia; Neutrophils; Prospective Studies; Random Allocation; Remission, Spontaneous

Treatment with zidovudine has been standard therapy for patients with advanced HIV infection, but intolerance is common. Previously, management of intolerance has consisted of symptomatic therapy, dose interruption/discontinuation, and, when appropriate, transfusion. The availability of new antiretroviral agents such as didanosine as well as adjunctive recombinant hematopoietic growth factors makes additional strategies possible for the zidovudine-intolerant patient. Because all of these agents are costly, we evaluated the cost implications of these various strategies for the management of zidovudine-intolerant individuals within a population of persons with advanced HIV disease. We performed a decision analysis using iterative algorithmic models of 1 year of antiretroviral care under various strategies. The real costs providing antiretroviral therapy were estimated by deflating medical center charges by specific Medi-Cal (Medicaid) charge-to-payment ratios. Clinical data were extracted from the medical literature, product package inserts, investigator updates, and personal communications. Sensitivity analysis was used to test the effect of error in the estimation of parameters. The models predict that a strategy of dose interruption and transfusion for zidovudine intolerance will provide an average of 46 weeks of therapy per year to the average patient at a cost of $5,555/year of therapy provided (1991 U.S. dollars). The models predict that a strategy of adding hematopoietic growth factors to the regimen of appropriate patients would increase the average amount of therapy provided to the average patient by 3 weeks (6%) and the costs attributable to therapy by 77% to $9,805/year of therapy provided.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Agranulocytosis; Algorithms; Anemia; Costs and Cost Analysis; Decision Support Techniques; Didanosine; Erythrocyte Transfusion; Erythropoietin; Granulocyte Colony-Stimulating Factor; Hematopoietic Cell Growth Factors; HIV Infections; Humans; Pancreatitis; Quality of Life; Zidovudine

Topics: Aged; Agranulocytosis; Anemia, Sideroblastic; Erythropoietin; Humans; Hypotension; Male; Neutropenia; Recombinant Proteins; Renin-Angiotensin System

In addition to standard peripheral blood cell counts, sequential studies have been made of changes in the T-lymphocyte population and in the serum titres of the presumptive humoral regulators of haematopoiesis, Colony Stimulating Activity (CSA) and Erythroid Stimulating Activity (ESA), in a young woman with cyclic neutropenia (CN). In addition, serum immunoglobulins, C3 and total complement levels and serum protein concentrations were determined on several occasions during the study. Similar tests were done concomitantly on a haematologically normal, age and sex-matched control. Cell counts on peripheral blood from the subject with CN demonstrated a clearly defined periodicity in neutrophil and monocyte concentrations and equivocal fluctuations in reticulocyte numbers. There was no evidence of periodicity in the lymphocyte concentrations and the T-lymphocyte population appeared functionally normal. Spontaneous incorporation of tritiated thymidine into peripheral blood cells showed a highly significant correlation with the monocyte count, suggesting that these cells were responsible for the radioisotope uptake. CSA titres were elevated on all occasions tested and showed no evidence of periodicity. ESA showed some evidence of cycling with elevated levels being observed during the periods of neutropenia. Serum complement levels were within the normal range but all classes of immunoglobulins were elevated and albumin levels were depressed.

Topics: Adult; Agranulocytosis; Blood Proteins; Colony-Stimulating Factors; Complement C3; Complement System Proteins; Erythropoietin; Female; Hematopoiesis; Humans; Immunoglobulins; Leukocyte Count; Lymphocyte Activation; Neutropenia; Recurrence; Rosette Formation; T-Lymphocytes

Following extensive bowel resection, a young woman experienced severe malnutrition; subsequent administration of parenteral nutrition precipitated the copper deficiency syndrome. This consisted of hypocupremia, subnormal ceruloplasmin levels, anemia, and severe neutropenia. The bone marrow was megaloblastic, vacuolated, and sideroblastic; granulocytic maturation was not observed beyond the myelocyte stage. Copper sulfate therapy was followed by a marked reticulocytosis, increase in hematocrit, and recovery of neutrophils. Additional studies indicated that both serum and urinary erythropoietin values were low; serum activity increased after copper supplementation. Abnormal granulopoiesis was demonstrated using the in vitro granulocyte colony assay. The patient's granulcoytic stem cells were normal on two occasions; however, mixing studies showed that culture of the patient's copper-deficient marrow with her copper-deficient serum yielded significantly reduced numbers of granulocyte colonies. Thus, copper appears to be a necessary element for normal hematopoiesis; lack of this trace element may result in ineffective erythropoiesis and granulopoiesis.

Topics: Adult; Agranulocytosis; Anemia; Bone Marrow Cells; Cells, Cultured; Colony-Stimulating Factors; Copper; Erythropoietin; Female; Hematopoiesis; Humans; Neutropenia

The marrow of a dog affected with cyclic neutropenia (CN) was transplanted into an unaffected supralethally irradiated litermate. Prompt engraftment occurred, and cyclic rises and falls in numbers of platelets, reticulocytes, and granulocytes were noted in the recipient soon after engraftment. Prior to transplantation and under hypoxic conditions, the donor had serum erythropoietin (ESF) peak levels at 11-12-day intervals. Following transplatation and under hypoxic conditions, cyclic peaks of ESF occurred in the transplanted dog.

Topics: Agranulocytosis; Ampicillin; Animals; Biological Assay; Blood Platelets; Bone Marrow Cells; Bone Marrow Transplantation; Dihydrostreptomycin Sulfate; Dog Diseases; Dogs; Drug Combinations; Erythrocytes; Erythropoietin; Hypoxia; Iron; Iron Radioisotopes; Leukocyte Count; Methotrexate; Neutropenia; Periodicity; Polymyxins; Radiation Chimera; Reticulocytes; Transplantation, Homologous

Topics: Agranulocytosis; Anemia, Aplastic; Anemia, Macrocytic; Bone Marrow Examination; Bone Neoplasms; Breast Neoplasms; Dihydrotestosterone; Erythropoiesis; Erythropoietin; Female; Hepatitis; Humans; Iron; Iron Radioisotopes; Male; Oxymetholone; Prednisolone; Sepsis; Transfusion Reaction

Topics: Aged; Agranulocytosis; Bone Marrow; Bone Marrow Cells; Cell Division; Child; Clone Cells; Erythrocyte Count; Erythropoietin; Feedback; Female; Humans; Leukocyte Count; Male; Periodicity; Proteinuria; Reticulocytes