Title: The Effect of Clozapine on Hematological Indices: A 1-Year Follow-Up Study
year: 2015
Journal: J Clin Psychopharmacol
Volume: 35
Issue: 5
Pages: 510-6
Epubdate: 13/08/2015
date: Oct
Alternate Journal: Journal of clinical psychopharmacology
ISSN: 0271-0749
DOI: 10.1097/jcp.0000000000000387
Accession Number: 26267420
Abstract: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and is linked to a need for mandatory hematological monitoring. Besides agranulocytosis, other hematological aberrations have resulted in premature termination in some cases. Considering clozapine's role in immunomodulation, we proceeded to investigate the impact of clozapine on the following 3 main hematological cell lines: red blood cells, platelets, white blood cells (WBCs), and its differential counts. Data were extracted from patients initiated on clozapine between January 2009 and December 2010 at a single hospital. Patients with a preclozapine complete blood count, who were receiving clozapine during the 1-year follow-up period, were included in the present investigation. Counts of red blood cells, platelets, WBC, and its differential including neutrophils, lymphocytes, monocytes, eosinophils, and basophils were extracted and trajectories plotted. One hundred one patients were included in this study and 66 remained on clozapine at the end of 1 year. There was a synchronized but transient increase in WBC, neutrophils, monocytes, eosinophils, basophils, and platelets beginning as early as the first week of clozapine treatment. There were no cases of agranulocytosis reported in this sample, and five developed neutropenia. A spike in neutrophils immediately preceded the onset of neutropenia in three of the five. The cumulative incidence rates were 48.9% for neutrophilia, 5.9% for eosinophilia, and 3% each for thrombocytosis and thrombocytopenia. Early hematological aberrations are visible across a range of cell lines, primarily of the myeloid lineage. These disturbances are transient and are probably related to clozapine's immunomodulatory properties. We do not suggest discontinuing clozapine as a consequence of the observed aberrations.
Notes: 1533-712x
J Clin Psychopharmacol. 2015 Oct
35(5):510-6. doi: 10.1097/JCP.0000000000000387.
URI: https://open-access.imh.com.sg/handle/123456789/4787
Authors Address: From the *Department of General Psychiatry 1, Institute of Mental Health
daggerOffice of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
double daggerSchizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
section signDepartment of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
parallelInstitute of Medical Science, University of Toronto
paragraph signGeriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
#Division of Clinical Pharmacology, Indiana University School of Medicine
**Indiana Clinical and Translational Sciences Institute, Indianapolis, IN
daggerdaggerCampbell Family Mental Health Research Institute
and double daggerdouble daggerDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Database Provider: Nlm
language: eng
Appears in Collections:2015

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