{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:07:47Z","timestamp":1780592867380,"version":"3.54.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clozapine is the gold-standard antipsychotic for treatment-resistant psychosis (TRP). Agranulocytosis is an important, potentially life-threatening adverse effect of clozapine treatment, and typically occurs during the first 6 months of treatment. Clozapine-induced agranulocytosis is thought to reflect bone marrow suppression; however, alternative hypotheses have not been reported or investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>We present the case of a 49-year-old female with TRP who experienced late-onset agranulocytosis after 8 years of clozapine treatment. She was subsequently evaluated by hematology and underwent bone marrow biopsy. After clozapine discontinuation, her absolute neutrophil count (ANC) normalized. She was subsequently treated with high-dose olanzapine, but had an inadequate therapeutic response. Within 3 months of clozapine rechallenge, she had a recurrence of agranulocytosis. Thereafter, hematology prescribed a 7-day course of prednisone 10\u00a0mg daily. One week later, her ANC increased from 500 to 1100\/mm3, consistent with increased demargination of neutrophils. Clozapine has since been continued with regular ANC monitoring. For the past 8 months, her ANCs have typically been 100-200\/mm3 (range, 0-500\/mm3). During this period, clozapine has been maintained at 400\u00a0mg\/day without interruption. She has never had any severe infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Although only single case, this report suggests the possibility of a different, non-life-threatening etiology for some patients with clozapine-induced agranulocytosis: namely, increased demargination of neutrophils rather than bone marrow suppression. Coordinated multispecialty care could help identify similar patients for whom clozapine can be safely continued or rechallenged.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/schbul\/sbag024","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:44:49Z","timestamp":1770209089000},"source":"Crossref","is-referenced-by-count":0,"title":["Clozapine-Induced \u201cPseudo-Agranulocytosis\u201d: Bone Marrow Suppression or Increased Neutrophil Margination?"],"prefix":"10.1093","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5056-4515","authenticated-orcid":false,"given":"Brian J","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Health Behavior, Augusta University , Augusta, GA 30912 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Ghani","sequence":"additional","affiliation":[{"name":"Division of Hematology & Medical Oncology, Department of Medicine, Augusta University , Augusta, GA 30912 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5290-9289","authenticated-orcid":false,"given":"Vamsi","family":"Kota","sequence":"additional","affiliation":[{"name":"Division of Hematology & Medical Oncology, Department of Medicine, Augusta University , Augusta, GA 30912 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026060412541708300_ref1","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1017\/S0033291719000369","article-title":"The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies","volume":"50","author":"Li","year":"2020","journal-title":"Psychol 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and benefits of clozapine and lithium co-prescribing: a systematic review and expert recommendations","volume":"268","author":"Verdoux","year":"2024","journal-title":"Schizophr Res"},{"key":"2026060412541708300_ref12","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/hup.1056","article-title":"Adjunctive use of lithium carbonate for the management of neutropenia in clozapine-treated children","volume":"24","author":"Mattai","year":"2009","journal-title":"Hum Psychopharmacol"},{"key":"2026060412541708300_ref13","first-page":"389","article-title":"Adrenergic modulation of neutrophil kinetics","volume":"95","author":"Berkow","year":"1980","journal-title":"J Lab Clin Med"}],"container-title":["Schizophrenia 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