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Table 21-9

Monitoring Granulocyte Counts During Clozapine Therapy

WBC and Granulocyte/Neutrophil CountAction Plan
I. Reduced WBC within normal range:
  1. WBC count drops 3000 cells from previous test
    OR
  2. Three or more consecutive drops regardless of their counts
I.
  1. Monitor for infection;
  2. CBC with differentials if ordered by physician;
  3. continue clozapine.
II. Mild leukopenia: WBC = 3000–3500II.
  1. Monitor for infection;
  2. CBC with differentials;
  3. continue clozapine.
III. Granulocytopenia: WBC = 2000–3000
Granulocytes/neutrophil = 1000–1500		III.
  1. Interrupt clozapine at once;
  2. start daily CBC with differentials;
  3. observe closely for infection;
  4. resume clozapine after normalization of granulocyte counts.
IV. Severe granulocytopenia: WBC <2000
OR
Agranulocytosis: Granulocytes/neutrophil <500		IV.
  1. Discontinue clozapine at once;
  2. consult with hematologist to consider protective isolation in a medical unit;
  3. daily CBC with differentials;
  4. clozapine must NOT be restarted at all.