Sodium valproate and thrombocytopenia.

Winfield, D.A.; Benton, P; Espir, Michael; Arthur, L J

doi:10.1136/bmj.2.6042.981

Cited by 49 publications

(18 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hematologic toxicity is being recognized more frequently with the higher serum concentrations needed for adequate seizure control. Thrombocytopenia (Winfield et al, 1976;Jaeken et al, 1979;Neophytides et al, 1979;Barr et al, 1982), leukopenia (Symon and Russell, 1983;Tettenborn et al, 1990), immune hemolytic anemia (Kaya et al, 1991), transient red blood (RBC) cell aplasia (MacDougall, 1982), bone marrow (BM) suppression (Smith and Boots, 1980), and macrocytosis (Sunder and May, 1988;Ganick et al, 1990) have been reported. Generally the number of patients reported has been small, and little information as to long-term effects has been available.…”

mentioning

confidence: 99%

Hematologic Manifestations of Long‐Term Valproate Therapy

1993

View full text Add to dashboard Cite

Sixty patients receiving long-term valproate (VPA) monotherapy were studied for hematologic side effects. All were patients in a long-term care facility and ranged in age from 2 to 29 years (mean 14.6 years). Twenty developed at least one prominent hematologic abnormality. Thrombocytopenia and macrocytosis were the most common findings. In patients with macrocytosis, platelet counts were inversely related to VPA levels. Serum B12 levels were increased in 51 of the patients. In 12 patients with macrocytosis who were extensively studied, no etiology for the increased MCV could be identified. An increased number of Pelger-Huet-like cells was noted in these 12 patients. None of the patients demonstrated hepatic dysfunction. Hematologic toxicity was never severe enough to discontinue therapy and always responded to small decrements in VPA therapy. VPA was discontinued in only 1 patient, owing to poor seizure control.

show abstract

mentioning

confidence: 99%

Hematologic Manifestations of Long‐Term Valproate Therapy

1993

View full text Add to dashboard Cite

show abstract

“…It may be transient and is caused by antibody-mediated platelet destruction; these antibodies are found in 45% of the patients on VPA therapy [1]. Dose-related thrombocytopenia has also been reported that disappears when VPA dose is reduced [4,11,15]. Transient or dose-related neutropenia and the Pelger-Huet anomaly have been observed during VPA therapy [3,5,13,14].…”

Section: Discussionmentioning

confidence: 95%

Haematological disturbances during long-term valproate therapy

Brichard¹,

Vermylen²,

Scheiff³

et al. 1994

Eur J Pediatr

View full text Add to dashboard Cite

A 14-year-old boy with mental retardation presented with severe thrombocytopenia, macrocytic anaemia and allergic dermatitis. He had been treated with valproate for seizures since the age of 2 years. Clinical examination showed severe purpura, mucous bleeding and extensive dermatitis. Tests to detect serum direct antiplatelet antibodies were positive and bone marrow examination revealed myelodysplastic abnormalities. Valproate was discontinued and both dermatitis and general condition of the child improved with normalization of the full blood count. This report suggests that valproate may produce both peripheral immune thrombocytopenia and severe bone marrow depression several years after the initiation of the therapy.

show abstract

“…In previous study, the reported frequency of VPA-induced thrombocytopenia has varied greatly and ranged from 0% to 32%. 7,10,[12][13][14][15][16][17][18][19] The strength of our study is that we conducted a longitudinal observational study in which the sequential assessment of platelets counts was done monthly to analyze the effect of VPA on platelet count.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 It is mild to transient in most cases which usually resolves spontaneously on dosage reduction or withdrawal of the drug. 6,7 Available reports showed that thrombocytopenia associated with VPA therapy has been reported to resolve without interruption of VPA treatment 8 and has also been reported to endure over time or to have an erratic course. 5 Reports on the use of VPA with psychiatric patients have described a drop in platelet count without thrombocytopenia or with a minimal incidence of thrombocytopenia 9,10 without any associated adverse clinical events related to this findings.…”

Section: Introductionmentioning

confidence: 99%