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The frequency of agranulocytosis in association with clozapine therapy has been estimated and compared with data reported for phenothiazine-induced agranulocytosis. Apart from the "epidemic" in Finland, where the frequency was 21 times that in other countries, there is no evidence that clozapine-related agranulocytosis is more common than the phenothiazine-related disorder. Furthermore, results are given to show that strict adherence to precautionary measure (e.g. weekly blood counts) reduces the mortality-rate of this condition.

Mrs. J. M. was without a history of transfusion or intramuscular injections of blood and since she was Group A, Rh(D) positive, the possibility that her second child, when delivered, would suffer from haemolytic disease of the newborn had not been considered. She was delivered a t term of a normal infant which became deeply jaundiced

SettingBased at a busy city hospital, the alcohol care team is a drug and alcohol specialist service, taking referrals for a wide range of patients with substance use disorders (SUD).ObjectivesPatients with SUD are at high risk of vitamin D deficiency; this relates to frequent fractures and proximal myopathy. The coronavirus pandemic brought vitamin D into focus. Local guidelines advise that patients at high risk of vitamin D deficiency are offered replacement. There were no local data on vitamin D deficiency prevalence or any mention of patients with SUD in local vitamin D guidelines. The main aim of this project was to offer vitamin D checks and replacement to all appropriate patients.ResultsWe collected data on 207 patients, [pilot study (n=50) and two subsequent samples (n=95 and n=62)]. Our pilot study showed that no patients were offered vitamin D testing or replacement. We then offered vitamin D checks to 95 patients. Most had low vitamin D (30 patients were vitamin D deficient and 26 were vitamin D insufficient). We provided vitamin D replacement and follow-up advice. Quality improvement was demonstrated 6 months later. We collected data on a further 62 patients who were all on our current or recent caseload. Following exclusions, nearly half (48%) of patients had had a vitamin D check. Almost all of these (95%) had low vitamin D (60% being classified as deficient).ConclusionsPatients had not been offered vitamin D replacement despite often having multiple risk factors for vitamin D deficiency. Vitamin D checks (and subsequent replacement) rose in frequency since the outset of this project. Local guidelines should add SUD as a risk factor for vitamin D deficiency. Hospital admission provides a rich opportunity to offer this simple intervention to patients who are often poorly engaged with community services.

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