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Neutropenia Red Result — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisNeutropenia Red ResultMRCPsych Paper B

A patient taking clozapine is registered under the standard UK haematological monitoring pathway and not the benign ethnic neutropenia pathway. Routine monitoring shows an absolute neutrophil count of 1.0 × 10^9/L. What is the most appropriate immediate action?

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Correct answer: C — Stop clozapine immediately and arrange daily full blood counts until recovery

An ANC of 1.0 × 10^9/L is a red result under the standard UK clozapine monitoring pathway because it is below 1.5 × 10^9/L. Clozapine must be stopped immediately after the first abnormal result; confirmation should not delay discontinuation. Full blood counts should then be obtained daily until haematological recovery, with monitoring for symptoms or signs of infection. Under the licensed pathway, the patient should not be re-exposed to clozapine. Twice-weekly monitoring while continuing treatment applies to an ANC from 1.5 to below 2.0 × 10^9/L, not this result. Dose reduction does not adequately manage clozapine-associated neutropenia, while standard monitoring or review after 1 month would expose the patient to progression to agranulocytosis and sepsis.

Reference: Clozapine Viatris 100 mg Tablets, Summary of Product Characteristics, section 4.4 'Low WBC count/ANC' and Table 1, revised February 2026. https://www.medicines.org.uk/emc/product/15498/smpc