1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-8-03-a 10.15844/pedneurbriefs-8-1-4 Anticonvulsant Toxicity Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Long-Term Valproate Hematologic Side Effects http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 01 1994 01 06 2016 8 1 3 3 Copyright: © 1994 The Author(s) 1994 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hematologic manifestations of long-term valproate therapy

Hematologic side effects in 60 patients, aged 2-29 years (mean 14 years), receiving valproate (VPA) monotherapy for >4 years in a long-term care facility, are reported from the Department of Pediatrics, East Carolina University School of Medicine, Greenville, North Carolina.

 Valproate Thrombocytopenia Hematologic Abnormalities

Hematologic side effects in 60 patients, aged 2-29 years (mean 14 years), receiving valproate (VPA) monotherapy for >4 years in a long-term care facility, are reported from the Department of Pediatrics, East Carolina University School of Medicine, Greenville, North Carolina. Hematologic abnormalities, especially thrombocytopenia, <130,000/mcl (12 patients) and macrocytosis (11), were demonstrated in 20 (33%) patients. With VPA levels >100 mcg/ml in 22 patients, the incidence increased to 55%. Platelet counts were inversely related to VPA levels; thrombocytopenia was corrected when VPA dosage was reduced. Three had anemia, and 3 had leukopenia. Serum B12 levels were increased (>1000 mcg/ml) in 51 (86%); folate levels were normal. Blood smears showed increased numbers of bilobed polymorphonucleic cells (Pelger-Huet-like cells), an anomaly commonly associated with VPA-induced macrocytosis. [1]

COMMENT. The authors recommend close regular surveillance of patients receiving valproate, with continuous attention to blood counts, especially platelets and mean corpuscular volumes. The early recognition of these relatively frequent blood count anomalies may lead to reduction in VPA dosage or drug withdrawal and avoidance of major hematologic toxicity.

 May RB Sunder TR Hematologic manifestations of long-term valproate therapy Epilepsia 1993 Nov-Dec 34 6 1098 1101 10.1111/j.1528-1157.1993.tb02139.x 8243362