title: Macrocytosis associated with divalproex treatment.
abstract: Divalproex (DVP) is increasingly prescribed to children and adolescents in psychiatric practices. Among the hematologic adverse effects of DVP, decreased platelet count is well described in the medical literature. However, to date, few studies describe the occurrence of macrocytosis as an adverse effect of divalproex. We report two cases of pediatric patients who developed macrocytosis and decreasing platelet counts secondary to DVP treatment. Because macrocytosis remained an asymptomatic nonprogressive condition for our patients, we support the recommendation for closer surveillance of the patients' complete blood counts for development of anemia in addition to thrombocytopenia.
authors.affiliation: Division of Child and Adolescent Psychiatry, The Zucker Hillside Hospital, New Hyde Park, New York 11040, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tsivkin
authors.forename: Ema
authors.initials: E
authors.lastname: Saito
authors.forename: Vivian
authors.initials: V
authors.lastname: Kafantaris
mesh_terms: D000748:Anemia, Macrocytic / Q000097:blood / Q000139:chemically induced*; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004909:Erythrocyte Indices; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D010976:Platelet Count; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced*; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid; D005492:Folic Acid; D014805:Vitamin B 12