Prevalence of agranulocytosis during treatment with clozapine in psychiatric hospitals in Mashhad, Iran

Document Type : Research Paper


1 Assistant professor of mycology and parasitology, Faculty of Medicine, Islamic Azad University, Branch of Mashhad, Mashhad, Iran

2 Associate professor of psychiatry, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Bachelor student of medical laboratory sciences, Islamic Azad University, Branch of Mashhad, Mashhad, Iran

4 General physician, Islamic Azad University, Branch of Mashhad, Mashhad, Iran


Introduction: Clozapine is an atypical antipsychotic agent that is more effective than standard antipsychotictic drugs in the treatment of patients with refractory schizophrenia. The main factor limiting its use is the risk of potentially fatal agranulocytosis. The aim of this study was to assessment the prevalence of clozapine-induced agranulocytosis and other white blood cell disorders among patients in psychiatric hospitals of Mashhad.
Materials and Methods: This study analyzed the data of 210 patients received clozapine in Ibn-e-Sina and Hejazi hospitals in Mashhad during September 2012 to September 2013. In most cases hematologic monitoring was weekly for the first 18 weeks, then it changed to every month. The questionnaires included demographic factors such as of age, gender, type of psychiatric disorder, duration of treatment, maximum dose of clozapine and concomitant antipsychotics were fulfilled through the patient’s medical records. Data analyzed by descriptive tests, chi-square and exact Fisher test.
Results: The patients included 102 males and 108 females with the mean age of 38.3 years. The duration of clozapine treatment was one month (37.6%) and 1-3 months (36.2%) The maximal daily dose for 56.2% of patients was 150-299 mg/day. 60.4% received concomitant antipsychotics. No case of agranulocytosis was seen but the following transient hematologic dysfunctions were showed in 20.4% decrease of white blood cell, anemia (4.7%), eosinophilia (11.4%), thrombocytopenia (9.5%), leukocytosis (3.3%) and chronic leukocytosis (2.3%). There were no significance between white blood cell decrease and age, usage dose, concomitant use of other antipsychotics (P>0.05), but the white blood cell reduction was more in women (P=0.01) and there also was a significance between white blood cell decrease and treatment duration (P=0.011). There was no case of agranulocytosis and mortality among leukopenic patients.
 Conclusion: Considering the lack of agranulocytosis in this study, it is recommended to lengthen the intervals of hematologic monitoring in patients who are under treatment with clozapine in order to be easier and more economical.