Blood lead and petrol lead.

Abstract

Agranulocytosis associated with MaloprimSIR,-The report by Dr G Friman and others (16 April, p 244) of the association of agranulocytosis with malaria prophylaxis using Malo- prim (dapsone 100 mg and pyrimethamine 12 5 mg) prompts us to record a similar case.A 52 year old English woman, who had previously been in good health, was referred to us by Dr D Gorst of Lancaster Royal Infirmary.She presented with a four day history of sore throat, fever, and headache, developing 10 days after her return from South Africa.While there she had been well but had taken Maloprim, one tablet twice weekly, during her six week stay, continuing with the same dose on her return.She had taken no other drugs.Full blood count showed a haemo- globin concentration of 11-2 g/dl, a platelet count of 395 x 109/1, and a white blood cell count of 0-9X 109/1.Bone marrow aspirate showed a total absence of granulopoietic cells with normal erythropoiesis, increased megakaryocytes, and increased plasma cells (450/).She died two weeks later of overwhelming septicaemia.Pseudomonas sp was cultured from the blood on three separate occasions.