Article

The Diagnosis and Treatment of Acute Agranulocytosis

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Abstract

PROMPT recognition of acute agranulocytosis is important because early and adequate treatment will effect a complete recovery in about 90 per cent of the patients. Penicillin, and to a lesser extent other antibiotics and chemotherapeutic drugs, have reduced materially the former high mortality rate.

The severity of the disease is demonstrated by the initial report of Schultz1 in 1922 in which 5 fatal cases were described, each characterized by extensive ulcerations of the mouth and pharynx, fever, and a pronounced decrease of the white blood cell count. He observed the profound diminution of the polymorphonuclear leukocytes and the total absence of these cells from the peripheral blood and suggested the name agranulocytosis. This report created world-wide interest and recognition of the clinical syndrome although Brown2 in this country is credited with the first authentic case report in 1902.

The term “agranulocytic angina” was introduced in 1923 and is generally accepted. Some of the more common synonyms include malignant leukopenia, granulopenia, and toxic myelosis. The latest edition (1942) of the Standard Nomenclature of Diseases of the American Medical Association recommends the name “acute agranulocytosis” under the inclusive term granulocytopenia.

Clinical Manifestations

The onset of the disease is usually abrupt but may be preceded by headache, malaise or mild prostration for 1 or 2 days. It has been shown that depression of the white blood cell count due to a decrease in the granulocytes occurs prior to the onset. The symptoms are usually sore throat, difficulty in swallowing, and fever indicative of. . .


 

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