QuestionSBA
QuestionChoice
Increasing the dose would exacerbate the risk of agranulocytosis, as clozapine is directly linked to this haematological side effect.
50436
c
Increase clozapine dose to 125mg PO BD
QuestionChoice
Clozapine is associated with a risk of agranulocytosis, a severe reduction in neutrophils. This patient has neutropenia (neutrophils <1.5x10⁹/L) and agranulocytosis (neutrophils <0.5x10⁹/L), making the continuation of clozapine unsafe. Immediate discontinuation is necessary to prevent life-threatening infections and further haematological decline.
50434
a
Stop clozapine immediately
QuestionChoice
Reducing the dose does not prevent further neutropenia or adequately address the agranulocytosis risk. This approach delays appropriate action and increases the risk of complications.
50435
b
Reduce clozapine dose to 75mg PO BD and repeat bloods in one week
QuestionChoice
Continuing clozapine in the presence of agranulocytosis is contraindicated. This approach puts the patient at significant risk of sepsis or other severe complications.
50438
e
Continue treatment and repeat bloods in one week
QuestionChoice
Monitoring at such an extended interval is unsafe given the acute risk of infection associated with agranulocytosis. The priority is immediate cessation and haematology referral.
50437
d
Reduce clozapine dose to 75mg PO BD and repeat bloods in one month
QuestionComment
Where can you find this in the BNF?
38581
QuestionComment
im wondering the same thing
39655
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subscriber
Just Another Med Student
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Yersinia Jaundice
QuestionComment
control f "agranulocytosis" in the clozapine monograph. under cautions
40239
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Neoplasia Nightshift
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3670
Clozapine increases the risk of agranulocytosis
Topic
90
Psychiatry
10141
Case Presentation: A 31-year-old female attends psychiatric outpatients for a review of her bloods.




 **PMH**
Schizophrenia
 **DH**
Clozapine 100mg PO BD
 **Investigations**



||||
|--------------|:-------:|---------------|
|White Cell Count|1.6x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|234x10<sup>9</sup>/L|150 - 400|
|Neutrophils|0.6x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|1.2x10<sup>9</sup>/L|1.5 - 4.0|
|Monocytes|0.5x10<sup>9</sup>/L|0.2 - 1.0|
|Eosinophils|0.2x10<sup>9</sup>/L|0 - 0.4|
|Basophils|0.08x10<sup>9</sup>/L|0 - 0.1|
|Sodium|136 mmol/L|135 - 145|
|Potassium|4.1 mmol/L|3.5 - 5.3|
|Urea|3.3 mmol/L|2.5 - 7.8|
|Creatinine|61 µmol/L|60 - 120|



Question: Select the most appropriate decision option based on this data
a