Severe Granulocytopenia Secondary to Chlorpromazine despite Concurrent Lithium Treatment: A Case Report

Chlorpromazine引起之白血球數目低下頗常見，但到達嚴重顆粒性白血球過少症之程度則為罕見。鋰鹽已被證實具有提高白血球數目的功能，但對於是否能預防藥物引起之顆粒性白血球過少症則尚未定論。本文報告一同時併用鋰鹽和chlorpromazine的雙極性情感性精神病病人，在血中鋰鹽濃度維持於治療範圍和接受chlorpromazine 每天50至150毫克的情況下，其白血球數目降至每立方公釐700個，並出現攝氏39度高熱和明顯上呼吸道感染。經骨髓穿刺以細胞學檢查發現，骨髓系列（myeloid series）在前骨髓細胞期（promyelocyte stage ) 有成熟休止（maturation arrest）的情況，而週邊血液抹片則發現顆粒性白血球數目明顯降低。上述結果均支持此個案為chlorpromazine所引起之嚴重顆粒性白血球過少症。經停用chlorpromazine和續用鋰鹽，並以抗生素處理感染後，個案的白血球數目在11天後回復正常範圍。文中並就鋰鹽對於藥物所引起顆粒性白血球過少症的預防和治療成效進行討論。

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並列摘要

Severe chiorpromazine-induced granulocytopenia where the white-cell count decreases to below 1,000/mm3 rarely occurs and lithium is known to cause leucocyto-sis. The use of lithium in the prevention of granulocytopenia induced by drugs is still controversial. This report describes a patient with bipolar disorder suffering from severe granulocytopenia and severe respiratory infection after receiving chlorpromazine 50 to 150 mg per day along with long term lithium therapy. Bone-marrow aspiration and biopsy revealed inhibited maturation of myeloid series in the promyelocyte stage. The findings were consistent with a drug-induced effect. White-cell count return to normal after the discontinuation of chlorpromazine. It was proved in this case that combined lithium therapy had no effect in preventing agranulocytosis Induced by chiorpromazine.

並列關鍵字

granulocytopenia ； chlorpromazine ； lithium therapy

國際替代計量

Severe Granulocytopenia Secondary to Chlorpromazine despite Concurrent Lithium Treatment: A Case Report

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