Should Dapsone Be Discontinued Based On The Attached Blood Reports?

Posted on Thu, 26 Oct 2017

Question:
Hello Doctor,
How are you doing?
My mom has been taking TB (brain and Lymphnode TB) medicines for over 2 years.
Currently taking Macoxplus(Rifampicin + Isoniazid)
She has recently been diagnosed with Hansen's disease. After reviewing her TB history and medicines, the doctor has prescribed the below medicines
(1) Continue Macoxplus 1 tab daily (has been taking this for over 2 years for TB)
(2) Dapsone 100 mg - 1 tab daily
(3) Hansepran 50 mg - 1 tab daily, Hansepran 300 mg - 1 tab, once a month.

Since regular blood tests have to be done for patients taking dapsone, we got her complete blood picture before starting dapsone and hansepran
Results before Dapsone - Everything was normal
(1) Haemoglobin 12.6 (Normal Range 12 to 15)
(2) Haematocrit(PCV) 37.9 (Normal range 36 to 46)
(3) RBC Count 4.65 (Normal Range 3.8 to 4.8)
(4) WBC Count 4900 (Normal range 4000 to 11000)
(5) Lymphocytes 21 (Normal range 20 to 40)
(6) Monocytes 10 (Normal Range 2-10)
Results after taking Dapsone for 2 weeks
1) Haemoglobin 10.8 (Normal Range 12 to 15)
(2) Haematocrit(PCV) 32 (Normal range 36 to 46)
(3) RBC Count 3.9 (Normal Range 3.8 to 4.8)
(4) WBC Count 4550 (Normal range 4000 to 11000)
(5) Lymphocytes 15.8 (Normal range 20 to 40)
(6) Monocytes 10.8 (Normal Range 2-10)

Haemoglobin, RBC count, PCV and lymphocytes have gone below normal. Monocytes is above normal and WBC has decreased from 4900 to 4550
Here are my questions
(1) Is this scenario Normal?
(2) Should dapsone be discontinued?
(3) if yes, are there any alternative medicines for dapsone
Please help me understand. Thank You for your time.
XXXXXXX

Answered by Dr. Dr. Rahul Kumar (29 minutes later)

Brief Answer:
Hemolytic anaemia

Detailed Answer:
Hello
Thanksfor the query.
There are chances of dapsone induced hemolytic anaemia.
Get a serum bilirubin level done.
If bilirubin levels are raised then hemolysis can be suspected and dapsone can be stopped.
The alternative therapy is called as ROM therapy where rifampicin, ofloxacin and minocycline are given for Hansen's disease.
This information should be benificial to you.
Let me know if you have any other doubts.
Thank you.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Rahul Kumar (50 minutes later)

Thank You for your quick response, Doctor XXXXXXX
My mom has multiple lesions,
(1) is the ROM therapy as effective as the Rifampicin, Dapsone and Hansepran therapy
(2) Is ROM therapy taken daily? and for how many months?
(3) Are there any potential side effects of ROM therapy?
Please advise. Thank You

Answered by Dr. Dr. Rahul Kumar (12 hours later)

Brief Answer:
Get bilirubin levels checked

Detailed Answer:
Hello
Thanks for the follow up.
ROM therapy is usually given in single lesion leprosy.
In your mother's case dapsone can be stopped and continue with rifampicin and clofazamine.
First get bilirubin levels assessed.
Let me know if you have any other doubts.
Thank you.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. Rahul Kumar (13 hours later)

Thank You, Doctor. We will get the bilirubin levels tested.

Also, our Doctor wanted my mom to continue the medicines for 2 more weeks and then based on the reports, wanted to see if we should stop the medicines.

Is it ok to continue dapsone for 2 more weeks? Please let me know. Thank You

Answered by Dr. Dr. Rahul Kumar (6 hours later)

Brief Answer:
She can continue

Detailed Answer:
Hello
Sometimes there is a transient hemolysis with dapsone which recovers in a month, so she can continue with the medicine for a month.
She can take iron tablets daily to induce more blood formation.
Let me know if you have any other doubts.
Thank you.

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Above answer was peer-reviewed by : Dr. Yogesh D