A case of pancytopenia.
Sodium valproate is a commonly used anticonvulsant, particularly in the management of childhood refractory epilepsy. There is a good literature base regarding its haematological effects in this group of patients including the potential for toxic effect on the bone marrow. Valproate is increasingly being used in the treatment of psychiatric conditions, particularly bipolar affective disorder. In this article we describe a case of pancytopenia associated with a valproate level of 166 mg/l. The population of psychiatric patients is different in several ways from the population of children and young adults with epilepsy from whom the existing data comes. The psychiatric patients are older, more likely to misuse substances, more likely to take overdoses and may metabolize valproate more slowly. For these reasons it would be worthwhile investigating the relationship between valproate levels, macrocytosis, platelet counts and B12 levels in this group of patients. The results of such a study would give us a clearer understanding of what the desirable therapeutic range is for valproate in bipolar affective disorder and what, if any, monitoring should be undertaken.
Keown
Patrick
P
Department of Psychiatry, University of Newcastle, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK. patrick.keown@nmht.nhs.uk
McAllister-Williams
Hamish
H
Young
Allan
A
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D005492:Folic Acid / Q000097:blood; D006801:Humans; D008297:Male; D010198:Pancytopenia / Q000097:blood / Q000139:chemically induced*; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D014635:Valproic Acid / Q000009:adverse effects*; D014805:Vitamin B 12 / Q000097:blood
D000927:Anticonvulsants; D014635:Valproic Acid; D005492:Folic Acid; D014805:Vitamin B 12