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Indian Journal of Hematology and Blood Transfusion

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01-06-2016 | Case Report

Methimazole Induced Total Myeloid Aplasia with Delayed Recovery Despite Granulocyte Colony Stimulating Factor (G-CSF): Marrow Progenitor Recovery Kinetics

Authors: Tania Sarker, Bülent Özgönenel, Manisha Gadgeel, Steven Buck, Amita Adhikari, Yaddanapudi Ravindranath

Published in: Indian Journal of Hematology and Blood Transfusion | Special Issue 1/2016

Abstract

An eighteen-year-old female with Graves thyrotoxicosis presented with methimazole-induced agranulocytosis and total myeloid aplasia. The bone marrow at presentation showed complete absence of myeloid precursors and striking plasmacytosis. 16 days later, myeloid precursors were still absent morphologically; however bone marrow flow cytometry and cell culture detected an improvement in myelogenesis, which was soon followed by clinical recovery of agranulocytosis. Neutrophil recovery was delayed until day 22 after cessation of methimazole despite G-CSF use, consistent with a direct toxic effect on committed myeloid cells. Our findings suggest that cell culture and flow cytometric evaluation of bone marrow myeloid progenitors can be used as a guide to anticipate neutrophil recovery.

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Title: Methimazole Induced Total Myeloid Aplasia with Delayed Recovery Despite Granulocyte Colony Stimulating Factor (G-CSF): Marrow Progenitor Recovery Kinetics
Authors: Tania Sarker
Bülent Özgönenel
Manisha Gadgeel
Steven Buck
Amita Adhikari
Yaddanapudi Ravindranath
Publication date: 01-06-2016
Publisher: Springer India
Published in: Indian Journal of Hematology and Blood Transfusion / Issue Special Issue 1/2016
Print ISSN: 0971-4502
Electronic ISSN: 0974-0449
DOI: https://doi.org/10.1007/s12288-015-0595-1

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