Trilineage hematopoietic toxicity associated with valproic acid therapy.
OBJECTIVE
Sodium valproate is commonly used as an anticonvulsant for patients with refractory epilepsy. Hematopoietic toxicity involving platelets or erythrocytes has been previously described, as well as a few cases of generalized bone marrow suppression.


METHODS
We report an infant receiving sodium valproate who developed severe anemia and thrombocytopenia, numerous circulating immature myeloid cells, and a coagulopathy. Bone marrow aspirate revealed approximately 40% abnormal promyelocytes, and the initial clinical and pathologic interpretation was consistent with the diagnosis of acute promyelocytic leukemia.


RESULTS
Antineoplastic therapy was withheld while valproate was weaned. All hematopoietic abnormalities resolved after valproate therapy was discontinued.


CONCLUSIONS
This report expands the clinical spectrum of hematopoietic toxicity associated with sodium valproate. Drug toxicity should be considered in any patient on valproate who develops hematopoietic abnormalities.
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K S
KS
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, U.S.A.
Adams
D M
DM
Mann
K P
KP
Ware
R E
RE
D019070:Cell Lineage / Q000187:drug effects*; D002648:Child; D005260:Female; D018682:GABA Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006410:Hematopoiesis / Q000187:drug effects*; D006412:Hematopoietic Stem Cells / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
D018682:GABA Agents; D014635:Valproic Acid