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Clozapine-Induced Agranulocytosis — RACP Adult Medicine MCQ

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EasyHaematologyClozapine-Induced AgranulocytosisRACP Adult Medicine

A 55-year-old woman on clozapine for treatment-resistant schizophrenia has a routine FBE showing ANC 0.4 × 10⁹/L (severe neutropenia). She was well with ANC 2.5 × 10⁹/L 2 weeks ago. She is afebrile. What is the most appropriate management?

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Correct answer: C — Cease clozapine immediately

ANC <0.5 on clozapine is a red result requiring IMMEDIATE cessation. Clozapine must never be restarted. Register the result with the monitoring service. If febrile with ANC <0.5 = febrile neutropenia requiring emergency IV antibiotics. G-CSF is given if ANC <1.0 and septic. Australia has mandatory clozapine monitoring: weekly FBE for 18 weeks, then monthly. ANC <1.5 = amber alert (increase monitoring); ANC <0.5 = red (cease permanently).

Reference: eTG Psychotropic – 2024 – Clozapine; TGA Clozapine Monitoring 2024