Labs Imaging Treatment Discussion

A 24-year-old female of Ashkenazi Jewish background complains to her family doctor of repeated URIs (due to neutropenia), increasing fatigue, muscle aches, and headaches.

She had been showing flattening of affect, suspiciousness, a delusional mood, and auditory hallucinations that were diagnosed as schizophrenia 3 years ago. She has been receiving clozapine treatment because other antipsychotics were unsuccessful.

VS: fever; tachycardia (HR 165). PE: patient in obvious discomfort; pallor (due to anemia); conscious and oriented to person, place, and time; petechiae (due to thrombocytopenia) on chest and arms; cardiopulmonary, abdominal, and genital exams normal; no extrapyramidal signs.

CBC: pancytopenia.

CXR: No signs of lung infection.

Discontinue clozapine and institute alternate pharmacotherapy.

Clozapine is used for the treatment of schizophrenia and psychotic disorders that are unresponsive to other therapy. It blocks Dh D2, and D., dopamine receptors as well as serotonin receptors. Because of its low affinity for D., receptors, clozapine causes few extrapyramidal symptoms. Agranulocytosis occurs in < 2% of patients, but all patients must receive weekly blood counts to monitor for this potentially lethal effect. Other side effects include seizures, sedation, and anticholinergic symptoms. Agranulocytosis usually reverses with discontinuation of clozapine.

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