Drug related/induced neutropenia

Blood Transfusion

A wide range of drugs can cause immune mediated neutropenia. However, these idiosyncratic reactions only occur in a small number of patients. There are several mechanisms for drug induced antibody mediated neutropenia. One established mechanism occurs when membrane glycoproteins bind to the drug to form a hapten. This causes the formation of antibodies which only bind to granulocytes in the presence of the drug. Quinine, and its stereoisomer quinidine, is known to cause drug dependent antibody formation via this hapten mechanism.

Other drugs have been reported to elicit the formation of antibodies. Alternatively, some drugs induce the formation of 'true' autoantibodies, which are able to bind granulocytes in the absence of any drug. These drugs appear to alter the homeostasis of the immune system resulting in autoimmunity against granulocytes in a small number of patients.

Notes

• Requires Consultant Haematologist approval
• Histocompatibility & Immunogenetics Granulocyte Immunology 3E required to request this test (form available from Transfusion laboratory or available using the link below)
• Performed at NHSBT, Bristol, Filton
• The following factors are known to significantly affect the performance of the examination or the interpretation of the results: lipaemia, sample clotted (if EDTA), haemolysed. Any sample displaying these factors cannot be processed and will be rejected

H&I Request Form (3E) - Granulocyte Immunology

Sample Requirements

Serum tube - 6mL

• Sample of implicated drug required together with the pharmacological concentration used

Sample requirements

Sample and request form must be labelled correctly with 4 points of reference:

1. Forename
2. Surname
3. Date of birth
4. NHS No.

The sample tube(s) must be signed and dated by the person taking the blood.

The NHSBT may decline to test inadequately labelled samples.

For further information on specimen labelling refer to the H&I 3E Granulocyte Immunology request form

Turnaround times

Up to 21 working days