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Antithyroid Drug-Induced Agranulocytosis: Is Routine White Blood Cell Count Effective for the Detection?

Takayuki Asawa, MD; Miyuki Arai, MD; Teiji Takeda, MD; Toru Aizawa, MD; Takashi Yamada, MD; Yutaro Onishi, MD
Arch Intern Med. 1992;152(1):204-207. doi:10.1001/archinte.1992.00400130194030.
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To the Editor. —  Tajiri and colleagues1 in their article on antithyroid druginduced agranulocytosis note that "... routine monitoring of the white blood cell count could be the most effective way of predicting and detecting..." the condition. Although the statement is true for the majority of the patients with this condition, "monitoring of the white blood cell count" is totally useless for the detection of antithyroid drug-induced agranulocytosis in some cases because agranulocytosis can occur in the presence of a normal total white blood cell count; such aspect of the problem is unduly neglected in the article.1 The authors only mentioned that the white blood cell count is normal in some cases until immediately before the development of agranulocytosis. We report herein our experience and result of the survey of English-language literature concerning this issue.

Report of a Case. —  A 57-year-old woman developed fever on March 14, 1990,


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