Co-administration of carbamazepine with clozapine increases the risk of which hematologic condition?

• A. Thrombocytopenia
• B. Leukemia
• C. Hemolytic anemia
• D. Agranulocytosis

Answer: (D)

When clozapine and carbamazepine are used together, the risk of agranulocytosis increases because both drugs can suppress the bone marrow and lower neutrophil counts. Clozapine already carries a well-recognized risk of severe neutropenia, which is why patients on clozapine require regular absolute neutrophil count monitoring. Adding carbamazepine, which can also cause leukopenia and neutropenia, heightens the chance of dangerous neutropenia (agranulocytosis).

Thrombocytopenia and hemolytic anemia involve other blood components (platelets and red cells, respectively) and are not the specific heightened risk with this combination. Leukemia is a malignancy, not an immediate drug-induced neutropenia threat in this context. Clinically, agranulocytosis presents with fever, sore throat, and infections due to severely reduced neutrophils, necessitating urgent evaluation and possible discontinuation of the offending drugs.