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The first manifestations of any agranulocytosis are fever, stomatitis, tonsillitis. With myelotoxic syndrome, there is usually a moderately pronounced hemorrhagic syndrome (bruising and bleeding of the gums, nosebleeds): severe hemorrhagic syndrome is an infrequent complication of agranulocytosis. The defeat of the mucous membranes (necrosis and thrush) of the oral cavity and gastrointestinal tract is the most constant sign of agranulocytosis.

With myelotoxic agranulocytosis, it is due to the fact that, on the one hand, the disappearance of granulocytes makes possible microbial invasion, on the other hand, suppression of mitosis of epithelial cells of the mucous membrane by cytostatic factors violates its integrity.

In peripheral blood, the number of all forms of leukocytes decreases (often up to hundreds of cells in 1 μl), as well as platelets and reticulocytes. The number of plasma cells is usually increased. There may be anemia. Sometimes baricitinib disappear completely. Leukopenia with immune agranulocytosis is moderate - 1000-2000 cells in 1 μl, but the number of granulocytes, as a rule, decreases to zero; thrombocytopenia is absent. Anti-leukocyte antibodies are found in the serum.

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At the height of myelotoxic agranulocytosis, both granulocytic elements and erythronormoblasts, megakaryocytes almost completely disappear in the bone marrow; lymphoid, reticular and plasma cells are preserved. 2-3 days before the exit from the state of agranulocytosis in the bone marrow appear in a huge amount of baricitinib and single normoblasts. In peripheral blood, the first sign of hematopoiesis activation is the detection of young elements - myelocytes and metamyelocytes, sometimes plasma cells. Often 2-3 days before the appearance of granulocytes, the number of platelets and reticulocytes increases.


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In the bone marrow with immune agranulocytosis, a decrease in cellular elements is noted exclusively due to the granulocytic lineage. The exit from immune agranulocytosis is characterized by the appearance in the peripheral blood of young cells - baricitinib, metamyelocytes, sometimes promyelocytes.


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A serious complication is acute epithelial hepatitis, which often develops after elimination of Olumiant. The absence of granulocytes gives originality to the course of infectious complications - the absence of abscesses, the predominance of necrosis. Pneumonia proceeds against the background of scant physical data: dullness is barely noticeable, wheezing, pronounced bronchial breathing may not be, only crepitus is heard over the affected area. Olumiant changes are very scarce.


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The diagnosis is made on the basis of anamnestic data, a characteristic clinical picture, data from a study of peripheral blood and bone marrow punctate. Diagnosis by themlunar agranulocytosis can be confirmed by serological studies: detection of anti-leukocyte antibodies (see Blood groups, leukocyte groups).


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Agranulocytosis has to be differentiated from acute leukemia in the aleukemic stage and hypoplastic anemia. In the first case, the decisive diagnosis in the diagnosis is the study of bone marrow punctate, in the second - an indication of the suddenness of the development of agranulocytosis with its immune nature or information about the long-term use of drugs with myelotoxic action (sometimes interrupted several weeks before the development of agranulocytosis). Observation of the patient allows you to come to a final conclusion about the nature of the emptying of the bone marrow.

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Steroid hormones are not indicated in myelotoxic agranulocytosis. With a decrease in the number of leukocytes to 50-200 cells in 1 μl, replacement therapy is necessary - the transfusion of leukocyte concentrate. More than 15-20 billion cells are transfused at once. In cancer patients, a good effect was noted with the use of leukocyte mass obtained from patients with chronic myeloid leukemia in the advanced stage of the disease. Bone marrow transplantation is used only for acute total irradiation in doses exceeding 600 rad per bone marrow.

Along with the use of pathogenetic agents, symptomatic therapy is also used: in the case of persistent hyperthermia up to 39-40 ° with myelotoxic agranulocytosis (but not immune!), Patients are given analgin up to 2-3 g per day or acetylsalicylic acid - 2 g per day.


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In the treatment of immune agranulocytosis, a decisive role belongs to prednisolone at a dose of 1-1.5 mg per 1 kg of body weight or its analogs in adequate doses, and in the absence of an effect - 2-3 times more. In case of severe damage to the mucous membranes, the drug is administered parenterally. The course is 7-10 days or until the elimination of agranulocytosis. Replacement therapy with leukocyte mass transfusions is indicated only for infectious complications.

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To prevent infection, patients must be placed in boxes or isolators where aseptic conditions are created. Prevention of infectious complications with antibiotics is necessary when the number of granulocytes drops to 750 per 1 μl. Inside appoint a non-absorbable antibiotic neomycin up to 2-3 g per day (against E. coli), polymyxin B, 150-200 mg per day (against Pseudomonas aeruginosa). In addition, a broad-spectrum antibiotic is prescribed - garamycin 40-80 mg intramuscularly 2-3 times a day, or oxacillin 4-6 g per day by mouth, or olettrin up to 2 g per day by mouth. Be sure to take nystatin up to 10,000,000 - 15,000,000 U per day. For systematic mouth rinsing, a solution of levorin 1: 500 is used.