Symptoms of agranulocytosis

With agranulocytosis, a characteristic symptom is the formation of ulcers, with a high rate. Necrotizing tissues extends not only to affected areas, but also to neighboring surfaces. At the same time, this process can acquire manifestations of nome, that is, water cancer, in which this pathological process passes to the mucous membrane of the cheeks, which causes gangrenous complications in the tissues of the face.

The same inflammation also affects the gastrointestinal tract, in which there are manifestations of ulcerative necrotic enteropathy. In this process necrosis of the mucous membrane of organs such as the esophagus, stomach and intestine is formed. Symptoms of this disease are expressed in the appearance of diarrhea, in some cases, with blood and vomiting. With a strong stage of necrotic lesions of the epithelium of the gastrointestinal tract, severe bleeding appears, which pose a threat to human life.

Some patients may develop jaundice, because the liver also undergoes tissue damage.

Sometimes, but rarely enough, perforation of ulcers is possible, in which all the clinical symptoms of the "acute abdomen" appear.

Perhaps, also, the emergence of pneumonia, which occurs quite untypically - with the emergence of abscesses, the development of gangrene and the penetration of the pathological process into the tissues of neighboring organs. In this case, the patient begins to worry about symptoms such as coughing, shortness of breath and chest pain (if the pleural effusion has begun). Severe cases of the disease accompany such a phenomenon as acute respiratory failure.

Sometimes with agranulocytosis there are diseases of the genitourinary system of infectious nature that affect the urethra and bladder, and in women - the uterus and the vagina. This is characterized by a feeling of pain and pain during urination, as well as pain in the lower abdomen. Women can also complain about the appearance of itching and pathological discharge from the vagina.

The processes of intoxication with agranulocytosis begin to trigger arterial and venous hypotension. If an auscultation of the heart is carried out, then the appearance of functional noise can be detected.

The processes in the kidneys are characterized by the symptom of albuminuria, that is, the release, together with the urine, of an increased amount of protein. Such changes are caused by the body's reaction to the spread of infections. If the kidneys are affected by infection through the penetration of pathological microorganisms from the urinary tract, then in the urine, you can observe the appearance of blood, as well as protein and cells that are lined with the epithelium of the renal tubules.

[2], [4]

Leukopenia and agranulocytosis

Granulocytes are a significant part of leukocytes, so agranulocytosis and leukopenia are two parallel processes that occur when the amount of granulocytes in the blood decreases.

Leukopenia is a critical decrease in the number of leukocytes in a unit of human blood. To diagnose leukopenia, the number of white blood cells should decrease to 4x109 per 1 μl of blood. Usually, this condition is temporary, and also characterizes many types of diseases, as one of the symptoms.

Leukopenia is of several types:

• It is caused by errors in the production of leukocytes,
• associated with problems in the movement of neutrophils and their migration from the bone marrow,
• caused by the destruction of leukocytes, which occurs blood vessels and their leaching from the body,
• caused by redistribution neutropenia.

With leukopenia, various infections rapidly develop in the body. The disease is characterized by the following symptoms:

• the presence of chills,
• increased body temperature,
• increased heart rate,
• the appearance of a headache,
• occurrence of an anxiety state,
• high degree of exhaustion.

In addition, the body begins to develop inflammation of various locations: in the mouth, in the intestine (in the form of ulcers), infection of the blood, inflammation of the lungs. Lymph nodes swell, tonsils and spleen increase.

Neutropenia and agranulocytosis

Neutropenia is the decrease in the number of neutrophils in the blood, which becomes critical. Neutrophils are a type of granulocyte, so neutropenia and agranulocytosis occur simultaneously. Sometimes agranulocytosis is called a critical neutropenia, because, and with another disease, one of the important symptoms is a sharply reduced level of neutrophils.

Neutropenia occurs when the number of neutrophils becomes less than one and a half thousand in one μl of blood. This leads to a decrease in human immunity, as well as an increase in the sensitivity of the body to the life of bacteria and fungi, which cause various infectious diseases.

Neutropenia is of several degrees:

• Light - from a thousand units in one μl of blood.
• Medium-heavy - from five hundred to one thousand units in one μl of blood.
• Heavy - less than five hundred units in one μl of blood.

The disease can be acute (occurs within a few days) or chronic (has developed over several months or years).

The threat of human life is a severe form of neutropenia in the acute form, formed due to a violation in the production of neutrophils.

Agranulocytosis and granulocytopenia

Agranulocytosis and granulocytopenia are different stages of the same phenomenon - a decrease in the number of granulocytes in the peripheral blood.

Granulocytopenia is characterized by a decrease in the level of granulocytes, which is not critical for human health. This disease may not manifest itself at all in the patient, proceed in a latent state and without any significant symptoms.

Agranulocytosis is a critical pathological condition that poses a threat to human health, and in some cases also to his life. Symptoms of the disease are quite bright, which is accompanied by severe changes in the patient's body. With agranulocytosis, complete disappearance of granulocytes from the blood plasma can be observed.

[5], [7], [9], [10], [11], [12]

Acute agranulocytosis

Agranulocytosis is divided into two forms - acute and chronic. This division is due to the cause of the disease.

Acute agranulocytosis manifests itself in a very strong and turbulent form. It is a consequence of acute radiation sickness and hapten agranulocytosis. The chronic form of the disease manifests itself gradually and is caused by chronic poisoning with benzene or mercury, lupus erythematosus, and agranulocytosis with metastatic bone marrow lesions and acute leukemia.

An acute condition is characterized by a sharp decrease in the amount of granulocytes in the blood serum, as well as a strong deterioration in the patient's condition against this background.

The possibility of recovery in acute manifestations of the disease depends on the level of granulocyte reduction. An important factor is the state of health of the patient along with his immune system before the deterioration of well-being. The timely and correct treatment is important.

In chronic forms of the disease, treatment methods and the chances of normalizing the condition depend on the course of the underlying disease, which agranulocytosis was provoked.

[15], [16], [17], [18],

Symptoms of myelotoxic agranulocytosis

Myelotoxic agranulocytosis can be of two types:

• exogenous origin,
• endogenous nature.

Let's consider more in detail each of these kinds of disease:

• Exogenous form of the disease is provoked by some external factors that have an adverse effect on the human body. Red bone marrow is very sensitive to many environmental factors, so the following points may affect the malfunctioning of its functioning:
  • radioactive radiation affecting a person,
  • poisonous poisons that suppress the function of hematopoiesis, such effects are known from the use of benzene, toluene, arsenic, mercury and so on,
  • reception of some kinds of medicines.

Based on the information received, it can be concluded that this form of agranulocytosis develops, as a consequence of severe damage to the body. And against the backdrop of the latter, the patient has symptoms of radiation sickness, benzene poisoning, cytostatic disease and so on.

The form of agranulocytosis caused by taking medications is curable. The effect is achieved by abolishing the pathogenic condition of the drug. In addition, it is important to know that after recovery the organism receives a greater resistance to the given drug, that is now problems with hematogenesis cause a greater amount of the drug.

This type of agranulocytosis is characterized by a pause between the external influence obtained and a strong decrease in the amount of granulocytes in the blood.

• Endogenous form of the disease is caused by internal factors of the organism, namely certain diseases. These include the manifestations:
  • acute leukemia,
  • chronic myelogenous leukemia, which passed into the terminal stage,
  • metastasis oncology, which sprouted into the bone marrow.

In this case, normal hematopoiesis is suppressed with the help of secreted tumor toxins. In addition, the cellular elements of the red bone marrow begin to be replaced by cancer cells.

Immune agranulocytosis

Immune agranulocytosis is characterized by the following clinical picture. With the development of this disease, the level of granulocytes decreases due to the high rate of their elimination with the help of anti-granulocyte antibodies. These antibodies can destroy granulocytes not only in the blood, but also in some organs, which are the most important for the blood composition. This applies to the spleen, lung, and red bone marrow. In some cases, the mechanism of destruction affects the cells that precede the formation of granulocytes, which is very similar to the myelotoxic form of the disease.

One of the symptoms of the disease is a strong intoxication of the body, in which there is widespread poisoning of organs and tissues with the help of the products of decay of the cells destroyed. But in some cases, signs of intoxication are mixed with the clinic of an infectious complication or with the symptoms of a major disease.

At laboratory researches of blood it is possible to observe absence of granulocytes and monocytes in full volume at practically saved quantity of lymphocytes. At the same time, the level of leukocytes is much lower than 1.5x109 cells per one μl of blood.

This type of agranulocytosis promotes the development of concomitant diseases, namely thrombocytopenia and anemia. This is due to the appearance of antibodies that destroy not only leukocytes, but also other blood particles. It is also stated that a polypotent cell derived from the bone marrow and being a precursor of granulocytes, erythrocytes and platelets can also test immune defeats.

Medicinal agranulocytosis

Medicinal agranulocytosis - a disease that is characterized by a decrease in the level of leukocytes due to the taking of certain medications.

This type of disease is divided into subspecies:

• myelotoxic - caused by cytostatics, levomycetin and other drugs,
• Hapten - provoked by the intake of sulfonamides, butadione and so on.

It happens that the same medication can cause different types of agranulocytosis in different people. These drugs include preparations of the phenotytic series - aminazine and others. For example, aminazine causes in a number of individuals who have idiosyncrasy to the drug, a myelotoxic type of agranulocytosis. But the same drug can provoke and immune type of disease in other persons.

Often a person under the influence of medical drugs, there are certain antibodies that destroy granulocytes and allow them to wash out of the body. This mechanism characterizes the haptenic form of the disease, which will be discussed in more detail below. The course of the disease is rapid and violent. And with the withdrawal of the drug, the pathological symptoms stop and the body recovers.

Other patients may complain of the development of autoimmune reactions, during which antibodies are formed directed against protein particles in the structure of leukocytes. For example, a similar clinic is characterized by systemic lupus erythematosus. In this case agranulocytosis develops at a slow pace and takes chronic forms.

Therefore, with drug agranulocytosis it is important to consider not only the characteristics of the drug, but also the individual factors of the patient. Human reactions can depend on his gender, age, level of immunity, the degree of diseases that can accompany pathology, and so on.

Symptoms of hapten agranulocytosis

Hapten agranulocytosis occurs when the process of subsidence of haptens called partial antigens occurs on the membranes of granulocytes in the human body. When the haptens are combined with antibodies that are placed on the surface of leukocytes, an agglutination reaction occurs-that is, a peculiar gluing of the granulocytes. Such a process leads to their death and a decrease in their quantity in the blood. Haptens can be considered different drugs, which led to a different name for this type of agranulocytosis, which is also called drug or drug.

The onset of haptenic agranulocytosis is very acute, often the bright symptoms of the disease appear immediately after the start of use of the drug. If you cancel the medication, the patient's body also quickly restores blood counts, which indicates an acute form of the disease.

An important characteristic of haptens agranulocytosis is that after recovery the human body will react pathologically even to the smallest dose of the drug that caused the disease.

Development of this disease is obtained at any age, but among children it occurs in fairly rare cases. Women suffer from the above pathology more often than men, but with age such a difference becomes invisible.

In elderly people, such a dysfunction of the body occurs more often and significantly. The explanation for this fact is in more medications taken because of deterioration in the health of older people. Also, the condition of the immune system deteriorates with age - it loses its flexibility, so there is a decrease in immunity, and the emergence of immune reactions of a pathological nature.

Specialists have evidence that the disease can be provoked by virtually any medication. But, nevertheless, there are a number of drugs that are most often responsible for the onset of hapten agranulocytosis. Pathological changes in the blood can be caused by:

A group of sulfonamides, which include drugs used in diabetes mellitus of the second type,

• analgin,
• amidopyridine,
• group of barbiturates,
• butadione,
• a number of anti-TB drugs, such as PASK, ftyvazidom, tubazidom,
• novocainamide,
• methiouracil,
• antibacterial drugs related to macrolides - erythromycin and so on,
• drugs with antithyroid effect, which are used in the hypertrophied function of the thyroid gland.

Agranulocytosis from Tyrosol

Tyrozole is a drug that is used to treat diffuse toxic goiter. Diffuse toxic goiter is inherently an autoimmune disease that is characterized by thyrotoxicosis, as well as the presence of goiter, ophthalmopathy and, in some cases, dermopathy.

With the use of Tyrozole, some patients may start agranulocytosis, that is, a decrease in the number of granulocytes in the blood below five hundred units per one μl of blood. Such a condition of the patient poses a threat to his health and life. In elderly patients, this complication occurs more often than in young patients. In some cases, the side effect of Tyrozole appears suddenly, for several days. But more often such complication develops slowly, within three-four months from the beginning of therapy.

Agranulocytosis from Tyrozol requires a number of measures:

• withdrawal of the drug,
• administration of antibacterial drugs,
• use of drugs with the effect of growth factor, which contribute to the rapid recovery of bone marrow.

If appropriate measures are taken, recovery of the patient can be expected within two to three weeks from the start of therapy. Although there were cases of death in a similar problem with the hematopoiesis system.

[20], [22], [25], [26], [27]