Late-Onset Neutropenia in Long-Term Clozapine Use and ItsManagement Utilizing Prophylactic G-CSF

This case outlines recurrent neutropenia after fourteen years of successful clozapine use. The patient has a diagnosis oftreatment-resistant schizophrenia which has been complicated by sensitivity to side effects of haloperidol and past failure ofantipsychotics to manage her symptoms. It was necessary for our patient to follow a complicated treatment path involving closemonitoring of blood levels, admissions, the initiation of lithium and the regular use offilgrastim (Neupogen), granulocytecolony stimulating factor (G-CSF). Following a failure of rescuefilgrastim to increase her neutrophil levels, a managementprotocol was designed with input from the on-site hematology team. This protocol involved the use offilgrastim on a regularprophylactic basis. This management plan has worked for the patient who has been able to continue use of clozapine and hasnot suffered from any neutropenic episodes in over six months