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Neutropenia in patients treated with clozapine during COVID-19 infection

Published online by Cambridge University Press:  13 August 2021

J. Marti Bonany ,
M. Pérez Carre ,
J.R. Fortuny Olive ,
C. Macias Castellví ,
E. Carrió Diez ,
R. Sánchez González ,
M. Vallve Elias ,
G.A. Mateu Codina  and
M.I. Martínez Casamitjana
J. Marti Bonany*
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
M. Pérez Carre
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
J.R. Fortuny Olive
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
C. Macias Castellví
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
E. Carrió Diez
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
R. Sánchez González
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
M. Vallve Elias
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
G.A. Mateu Codina
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
M.I. Martínez Casamitjana
Affiliation:
Institut De Neuropsiquiatria I Addiccions, Parc de Salut Mar, Santa Coloma de Gramenet, Spain
*
*Corresponding author.

Abstract

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Introduction

Clozapine is the most effective antipsychotic for treatment resistant schizophrenia but adverse reactions to clozapine include neutropenia. Patients with COVID-19 infection frequently experience lymphopenia, but not neutropenia.The impact of clozapine treatment in the presence of COVID-19 is unknown

Objectives

Show 2 cases of neutropenia in patients treated with long-term clozapine during COVID-19 infection.

Methods

Subjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020.

Results

16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine; 2 presented neutropenia. 1- 56-year-old woman diagnosed with schizophrenia on clozapine since 2009. Begins to have a dry cough and fever with positive COVID-19 swab (day 0). Slight leukopenia without neutropenia was observed on day 1. On day 7, neutropenia was observed with an absolute neutrophil count (ANC) of 1100. We decided to suspend clozapine and to initiate daily hematological controls. The ANC on day 8 was 970. Over the next few days the ANC will progressively improve until neutropenia resolved (day 22). 2- 55-year-old woman who required a transfer to a general hospital because of respiratory complications from COVID-19. She presented significant leukopenia (1’01x 10^3/uL) and neutropenia (ANC 100). Clozapine was not withdrawn. She was treated with granulocyte colony-stimulating factor.

Conclusions

An urgent full blood count will be required to exclude neutropenia with appropriate action. Further research will be needed to clarify the possible relationship between COVID-19, clozapine and neutropenia.

Disclosure

No significant relationships.

Keywords

clozapineneutropeniaCOVID-19
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S658
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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