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Background: Neutropenia is a serious side effect of psychopharmacological treatment. Neutropenia is defined as less than 0.5 x 109/L mature neutrophil cells. Patients with such severe acute neutropenia are likely to experience life-threatening and sometimes fatal infections. This report includes a case, who developed leukopenia and neutropenia due to venlafaxine use and a review of the relevant literature.
Case: A 27 year-old, married female patient, who had a history of major depression and used venlafaxine 75mg/day for 6 months 5 years ago. The patient reported a significant decrease in psychiatric symptoms and no side effects due to the treatment in this period. The patient reported that the symptom remission had been sustained for 4 years. She reported that complaints including anxiety, palpitation, dyspnea, paresthesia, and fear of death started recently following a psychosocial stress. A psychiatrist prescribed venlafaxine 75mg/day with a diagnosis of panic disorder. After one month a complete blood count test was performed because the patient complained of fatigue. It indicated neutropenia and leukopenia (neutrophil count, 1.2K/uL; leukocyte count, 3.26K/uL). The same test was repeated after 2 weeks and it indicated a progression in severity of neutropenia and leukopenia (neutrophil count, 0.37K/uL; leucocyte count,2.38K/uL). She had no other concerning pharmacological agent. Because medical evaluations found no other medical problem associated with neutropenia, venlafaxine was stopped. Two weeks later, the neutrophil count was 2.54K/uL and the leukocyte count was 4.77K/uL. The patient's hematological table recovered within one month.
Conclusion: Neutropenia and leukopenia have never been reported during treatment with venlafaxine. A case presentation of neutropenia is reported with combined treatment of mianserin and venlafaxine. When neutropenia and/or leukopenia develop during a drug treatment the drug should be stopped immediately. Blood cell counts can return to normal after stopping the drug. In our case blood cell counts were completely normal in 2 weeks after stopping venlafaxine. It is important to consider routine blood tests in psychopharmacological treatments.
References:
1. Anghelescu I, Klawe C, Dahmen N. Venlafaxine in a patient with idiopathic leukopenia and mirtazapine-induced severe neutropenia. J Clin Psychiatry 2002; 63(9):838.
2. Andrès E, Maloisel F. Idiosyncratic drug-induced agranulocytosis or acute neutropenia. Curr Opin Hematol 2008; 15(1):15-21.
3. Lucht MJ, Kleinschmidt R, Maier W, Rietschel M. Agranulocytosis during treatment with mianserin and venlafaxine. J Clin Psychopharmacol 2000; 20(4):490-1.