Neutrophil recovery characteristics in patients with severe antithyroid drug-induced agranulocytosis: A 12-year retrospective study.

چکیده اصلی

BACKGROUND: Antithyroid drug-induced agranulocytosis (TIA) is a serious adverse effect in Graves' disease treatment. This study aims to analyze neutrophil recovery patterns in TIA patients. METHODS: We conducted a 12-year retrospective study of patients with Graves' disease diagnosed with TIA. Primary objective was to characterize the recovery patterns of absolute neutrophil count (ANC) after severe agranulocytosis. Secondary objective was to identify factors associated with leukocytosis during granulocyte colony-stimulating factor (G-CSF) treatment using univariate and multivariate logistic regression. RESULTS: 48 TIA patients were included; 43 (89.6%) had a nadir ANC ≤ 0.1 × 10⁹/L (the severe agranulocytosis). Among 36 patients with detailed records, 77.8% had ANC ≤ 0.1 × 10⁹/L persisting 3-8 days. In the slow recovery group (> 3 days, n = 41), 62.5% exhibited rapid increase, with ANC surging from (0.1-0.5) × 10⁹/L to ≥ 0.5 × 10⁹/L within one day. 18 patients developed leukocytosis during G-CSF treatment. Univariate analysis showed that severe agranulocytosis lasting > 3 days significantly associated with leukocytosis (OR = 4.47, 95% CI: 1.05-18.94, P = 0.042). This association remained significant after adjusting for total G-CSF dose (OR = 7.72, 95% CI: 1.37-43.38, P = 0.020), and after further adjusting for sex, age, and total G-CSF dose (OR = 9.66, 95% CI: 1.52-61.36, P = 0.016). CONCLUSIONS: In most severe TIA patients, neutrophil recovery exhibited a biphasic pattern, with ANC recovering rapidly after prolonged severe agranulocytosis. Close monitoring is essential to avoid G-CSF overstimulation, particularly in patients with prolonged severe agranulocytosis.

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