Which one of the following can cause Agranulocytosis most commonly?

(A) Alkylating agentsMost common cause for agranulocytosis is drug toxicity.#Agranulocytosis is acute condition involving severe and dangerous leukopenia.BONE MARROW SUPPRESSIONCause by almost all anticancer drugs except Bleomycin, Vincristin & Asparginase.Most serious toxicity & often limit dose of chemotherapyGranulocytopeniaAgran ulocytosisThrombocytopeniaAplastic anemiaLymphocytopeniaComplications:Opportunistic infectionsBleedingDrug causing severe MyelosuppressionCarmustinCytarabineDaunorubicinePaclitaxelAlkylatinq aqentsAntimetabolitesAlkylating agents are cell cycle non specific cytotoxic drugs used in cancer chemotherapy.These drugs damage primarily the rapidly growing and multiplying tissues such as bone marrow, GIT and reproductive system.Bone-marrow suppression manifests as leukopenia, agranulocytosis, thrombocytopenia and aplastic anemia.CAUSES OF AGRANULOCYTOSISDisease relatedAgranulocytosis (neutrophil count <500/mlDrug relatedDisease RelatedDrug - Related (70% of cases)Congenital neutropeniaXChemotherapyXHematological diseaseLess likelyNon-chemotherapy drugs?Autoimmune diseaseLess likely Certain infectionLess likelyBacterial: Typhoid fever, Shigella enteritis, Brucellosis & TuberculosisViral: EB Virus, CMV, Hepatitis virus, Parvovirus B19Parasitic: Kala azar, Malaria CAUSES OF LEUCOPENIADecreased production:Peripheral destructionPeripheral pooling (transient neutropenia)Drug-induced:*. Alkylating agents (nitrogen mustard, Busulfan, chlorambucil, cyclophosphamide); antimetabolites (Methotrexate, 6-mercaptopurine, 5-flucytosine);*. Non-cytotoxic agents: *. Hematologic diseases- idiopathic, cyclic neutropenia, Chediak- Higashi syndrome aplastic anemia, infantile genetic disorders, Tumor invasion, myelofibrosis*. Nutritional deficiency - vitamin B12, folate (especially alcoholics)*. Infection- tuberculosis, typhoid fever, brucellosis, tularemia, measles, infectious mononucleosis, malaria, viral hepatitis, leishmaniasis, AIDS*. Antineutrophil antibodies and/ or splenic or lung trapping Autoimmune disorders- Felty's syndrome, rheumatoid arthritis, lupus erythematosus*. Drugs as haptens- aminopyrine, a-methyldopa, phenylbutazone, mercurial diuretics, some phenothiazines*. Wegener's granulomatosis*. Overwhelming bacterial infection (acute endotoxemia) Hemodialysis*. Cardiopulmonary bypassOther Options#Corticosteroids: Side effects depend on the dose of medication you receive and may include:Elevated pressure in the eyes (glaucoma), Fluid retention, pedal edema, High blood pressure, Problems with mood, memory, behavior and other psychological effects, Weight gain, with fat deposits in abdomen, face and the back of your neck#Paracetamol: Side effects from paracetamol are rare, but can include:an allergic reaction, which can cause a rash and swelling flushing, low blood pressure and tachycardia - this can sometimes happen when paracetamol is given intravenous causes thrombocytopenia (low number of platelet cells) and leukopenia (low number of white blood cells) liver and kidney damage on overdose - this can be even fatal in severe cases