Leukopenia and medication

[sweetlenovo88]

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Inherited a patient found to have a wbc of 2.6 and I have been tapering her off tegretol. Only other medication is prozac. The rest of the cbc is wnl except for absolute lymphocytes which is low. I had her see the PCP who is not concerned. She has a diagnosis of SAD that is not sympotomatic and has not be on an antipsychotic since 2014. Staff is c/o is more irritable/hyperverbal. What mood stabilizers/antipsychotics are least likely to exacerbate leukopenia?

 

[PistolPete]

What ethnicity is she? Maybe it's BEN?

 

[sweetlenovo88]

White


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[tr]

What's her anc and what's the chronicity of this? Is the PCP unconcerned because she's had it for decades? Does it predate the meds? If it's recent I'd be concerned, would like to know more about why PCP is not.

 

[sweetlenovo88]

ANC is 1.8. Lab tests from 06/15 show WBC-3.1 and anc-2.3. Case worker from group mentioned PCP is not concerned but her English is poor and I do not consider her reliable


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[Gambler 101]

Would it be worth checking HIV and getting a peripheral smear?


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[perox124]

Start her on Lithium.

 

[Merovinge]

ANC is 1.8. Lab tests from 06/15 show WBC-3.1 and anc-2.3. Case worker from group mentioned PCP is not concerned but her English is poor and I do not consider her reliable

Bit confused. She was on Tegretol and you are now worried about irritability/hyperverbal state but her diagnosis is SAD, is that referring to a seasonal patter to bipolar affective disorder? If she does suffer from bipolar disorder and we are titrating off her Tegretol (which is reasonable given the decline in ANC/WBC), lithium is a great choice. However, also just taking off the Prozac may help as she would be on an unopposed SSRI with seeming bipolar states/tendencies.

 

[HarryMTieboutMD]

Blood dyscrasias can happen with tegretol, but they are rare and should resolve with med discontinuation. Also echo above- did you mean seasonal affective disorder or schizoaffective? From the antipsychotic comment I'm guessing the latter... Probably needs some diagnostic verification (esp given how worthless a dx of Schizoaffective DO is in the first place...) before making other drug changes. If you clarify the diagnosis and ditch the prozac, agree with Lithium- MOA for leukocytosis is actually mediated through production G-CSF (from what I've read).

 

[sweetlenovo88]

Blood dyscrasias can happen with tegretol, but they are rare and should resolve with med discontinuation. Also echo above- did you mean seasonal affective disorder or schizoaffective? From the antipsychotic comment I'm guessing the latter... Probably needs some diagnostic verification (esp given how worthless a dx of Schizoaffective DO is in the first place...) before making other drug changes. If you clarify the diagnosis and ditch the prozac, agree with Lithium- MOA for leukocytosis is actually mediated through production G-CSF (from what I've read).

Thanks