Agranulocytosis is a symptom complex marked by a deficit or absolute lack of granulocytic white blood cells. The condition is also referred to as granulocytopenia and neutropenia.

Neutropenia, which refers to an abnormally small number of neutrophils, usually develops when neutrophil use is rapid and production is impaired. Secondary neutropenia may be due to bone marrow replacement by malignancy, radiation, chemotherapy, immunosuppression, vitamin B12 deficiency, alcoholism, infections, hypersplenism, induction by drugs, and autoimmune disorders.

Signs of infection may be markedly diminished or absent. There may be lesions in the throat and other mucous membranes, and lesions of the gastrointestinal tract and skin. Signs and symptoms may include:

• fever

•  cellulitis of the skin

•  liver abscesses

•  furunculosis

• pneumonia

• septicemia

Other signs and symptoms may include:

• stomatitis

• gingivitis

• inflammation of the rectal area

• colitus

• sinusitis (see Diagnostic Code: 6510, 6511, 6512, 6513, or 6514 Sinusitis, chronic)

• otitis media

In acute agranulocytosis, serious bacterial infections may occur such as typhoid fever, tuberculosis (see Diagnostic Code: 6730 Tuberculosis, pulmonary, chronic, active), and sepsis. The risk of infection is influenced by the integrity of the skin and mucous membrane, the blood supply to tissue, and the nutritional status of the person.

Tests may include: x-rays; complete blood count (CBC); bacterial and fungal blood cultures and sensitivities; cytology studies; x-rays of suspected sites of infection; and stool cultures.

Treatment will depend on the severity and cause of the condition. If the condition is due to prescription drugs, the drugs are stopped immediately. Broad-spectrum antibiotics are used and adjustments are made after drug sensitivity study results are obtained. Drugs such as granulocyte-macrophage colony stimulating factor (GM-CSF) and granulocyte colony stimulating factor (G-CSF) may be considered for use. The duration and severity of the condition are determined before considerations are given to perform bone marrow transplantation.

The condition may be life-threatening depending upon the severity and causes of the condition. Long-term management may be required. A reduction in the blood neutrophils usually leads to an increased susceptibility to bacterial and fungal infections. There may be recurring infections, and the need for repeated blood transfusions.

• None.

• A 100 percent evaluation for bone marrow transplant shall be assigned as of the date of hospital admission and shall continue with a mandatory VA examination six months following hospital discharge. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e).