Valproic acid-induced thrombocytopenia and leukopenia: case report and literature
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1413Keywords:
thrombocytopenia, leukopenia, valproic acid, bicitopenia, hematologyAbstract
Introduction: Valproic acid is a mood stabilizer in psychiatric practice and is one of the best treatment options for Bipolar Affective Disorder, particularly in rapid cycling. Its commonly associated side effects include tremors, fatigue, gastrointestinal disturbances, weight gain, and the most common hematologic side effect, thrombocytopenia. Valproic acid-induced leukopenia, particularly neutropenia, although reported, is quite rare, especially in adults. Objective: To present a case of thrombocytopenia and leukopenia induced by valproic acid and to highlight the monitoring of two rarely reported side effects in the literature – thrombocytopenia and leukopenia – when using this medication. Method: A case report and literature review through the Pubmed database from the last 5 years. UFPR, CAAE: 2.81770024.0.0000.0102. Results: A patient with Bipolar Affective Disorder (BAD) type I was admitted to a Day Hospital due to a difficult-to-control mixed episode. After medication adjustment and the introduction of valproic acid (valproate level 58), thrombocytopenia and leukopenia developed. Despite dose adjustments, the hematologic changes persisted. The drug was discontinued and replaced with lithium carbonate, with a good therapeutic response and normalization of laboratory tests after four weeks. Valproic acid (VPA) is associated with hematologic effects such as thrombocytopenia, leukopenia, and neutropenia, with thrombocytopenia being the most common. These effects usually occur within the first two years of treatment and can be asymptomatic. Leukopenia and neutropenia are rare, mainly in children and patients with epilepsy, and may be exacerbated by combinations with other drugs, such as quetiapine. Treatment for thrombocytopenia is typically self-limited, while neutropenia may require discontinuation of the drug in moderate to severe cases. Myelotoxicity is more concerning in the elderly due to the reduced cellular density of the bone marrow with age. Conclusion: Valproic acid can cause hematologic changes that require further studies and updates on the subject to guide management. A careful and attentive look is essential to improve clinical practice and offer, in addition to efficacy, safety in treatment.
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