Aripiprazole-Induced Neutropenia in a Seven Year-Old Male: A Case Report

Abstract

Blood dyscrasias are the widely known side effect of the second-generation antipsychotic medications. Aripiprazole rarely causes hematological side effects and it is considered relatively safe. We present the case report of a seven-year-old male who developed acute neutropenia a week after starting aripiprazole. His absolute neutrophil count (ANC) arose spontaneously once the medication was stopped. Clinicians should periodically check ANC in the patients taking aripiprazole as neutropenia could be lethal in extreme cases. To our knowledge, this is the first case report of leukopenia associated with aripiprazole in the child and adolescent population.

Suspected Aripiprazole-induced neutropenia in a geriatric patient: a case report

“…This trend is consistent with the patient described in this study as his blood levels (WBC and ANC) began to uptrend after the fourth day of discontinuing aripiprazole, with baseline levels achieved after 7 days. In the reported cases that included follow up laboratory studies after hospital discharge; at 2 weeks [5,7], 4 weeks [5,8], and 6 months [5]; WBC and ANC counts remained within normal limits with each post-hospitalization CBC. Given these previous findings, in patients who do not restart aripiprazole after an adverse neutropenic reaction occurs, follow up CBC's does not appear to be necessary or revealing.…”

“…A consideration in determining causality was lacking from this study, re-challenging the suspected agent. However, in the few similar cases where patients were re-challenged with aripiprazole, they invariably developed neutropenia again [4][5][6][7][8][9][10][11][12]21]. Additionally, given the risks associated with neutropenia (particularly in the context of patients who are hospitalized having higher risk of nosocomial infections), risks outweighed the benefits of re-challenging aripiprazole in this patient.…”

“…This is the first descriptive case report of suspected aripiprazole-induced neutropenia in a geriatric patient. While a few cases of aripiprazole-induced neutropenia have been documented in the literature for younger age groups [4,5,[7][8][9][10], the true incidence of this adverse reaction is not known as regular monitoring of CBC with aripiprazole use is not the current standard of care [13][14][15]. There is potential for concern, as neutropenia can be a life-threatening condition, especially in specific populations such as an elderly patient who may already be suffering from comorbid conditions and/or immunosuppression.…”

“…Although this patient was lost to follow up so no posthospitalization lab work was able to be obtained, review of the literature of similar studies showed that both children and adults had their blood levels (WBC and ANC) uptrend within 3-4 days after discontinuing aripiprazole with baseline levels being achieved by 1 week [4][5][6][7][8][9][10][11][12]21]. This trend is consistent with the patient described in this study as his blood levels (WBC and ANC) began to uptrend after the fourth day of discontinuing aripiprazole, with baseline levels achieved after 7 days.…”

“…are more common adverse reactions, hematological abnormalities associated with aripiprazole use are rare. Existing literature is limited, with documented neutropenia associated with aripiprazole use in children in three case-reports [4][5][6]; and some case reports in adults [6][7][8][9][10][11][12]. The FDA Adverse Event Reporting System (FAERS) Public Dashboard lists 10 suspected cases of aripiprazole-associated neutropenia in geriatric patients; but to our knowledge, there is no published literature describing aripiprazoleinduced neutropenia in a geriatric patient.…”