A patient on clozapine develops absolute neutrophil count (ANC) <500/mm3. Apart from stopping clozapine, which haematopoietic agent can be used to accelerate recovery of neutrophil count?

• A Erythropoietin (EPO)
• B Thrombopoietin receptor agonist (eltrombopag)
• C Granulocyte colony-stimulating factor (G-CSF, filgrastim) ✓
• D Granulocyte-monocyte colony-stimulating factor (GM-CSF, sargramostim) only if G-CSF unavailable

Explanation

Clozapine-induced agranulocytosis (ANC <500/mm3) is a life-threatening complication occurring in approximately 1% of patients. After stopping clozapine, G-CSF (filgrastim) stimulates proliferation and differentiation of neutrophil progenitors, accelerating ANC recovery. EPO acts on erythroid progenitors; eltrombopag is for thrombocytopenia; both G-CSF and GM-CSF can be used but G-CSF is first-line for pure neutrophil recovery.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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