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Agranulocytosis was previously estimated to occur in 0.8% of the patients receiving clozapine during the first year of treatment, with a peak incidence at 3 months. However, a system of hematological monitoring has reduced agranulocytosis-related fatalities to extremely low levels (Honigfeld et al. 1998). The dispensing of clozapine in the United States is linked to weekly WBC counts during the first 6 months and biweekly counts thereafter. Strict guidelines based on WBC and absolute neutrophil counts have been set (Table 26–12). Since the implementation of the Clozaril National Registry in the United States, the rate of agranulocytosis has been estimated to be 0.38% on the basis of data collected from February 1990 to December 1994 (Honigfeld 1996; Honigfeld et al. 1998).

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Table Reference Number
TABLE 26–12. Hematological monitoring guidelines for patients taking clozapine

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