Clozapine Treatment and Thrombocytopenia : A case report

Abstract

Clozapine is an atypical antipsychotic drug, which is effective for the treatment of resistant schizophrenia1 . It is suggested to use clozapine for schizophrenia cases in which no response is obtained from two different antipsychotics2. Clozapine treatment was forbidden after the death of 8 schizophrenia patients in Finland in 1974, due to agranulocytosis. However, because of its high efficacy and the lack of alternatives in treatment resistant schizophrenia, it has been approved in schizophrenia with intense hematological monitoring3. Clozapine associated thrombocytopenia is a rare complication and there is limited number of published literature on this subject4-6. The hematologic side effects of clozapine are usually associated with leukocytes and neutrophils, therefore its effects on thrombocytes might be ignored. Thrombocytopenia, which is defined as a platelet count below 150*109 /L, can cause mortality especially associated with bleeding, when platelet count is below 10*109 /L. We aimed to present a clozapine related thrombocytopenia and its management in a residual schizophrenia case, which did not respond to any antipsychotics except clozapine; and to review the literature on this subject.