Valproic Acid Induced Thrombocytopenia and Dysmegakaryopoiesis in a Pediatric Patient

Akgun, Yamac
Baykara, Yigit
Langlie, Jake
Van Truong, Lance
Poveda, Julio

¹Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, ²Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, ³University of Miami Miller School of Medicine, University of Miami and Jackson Health System, Miami, FL, and ⁴Department of Pathology and Laboratory Medicine, University of Miami and Jackson Health System, Miami, FL, USA

Address correspondence to Yigit Baykara, MD; Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Rhode Island Hospital, Providence, RI, 02903, USA; phone: 401 428 0832; e mail address: [email protected]

Annals of Clinical & Laboratory Science 52(5):p 843-845, September-October 2022.

Abstract.

Objective.

Valproic acid (VPA) is an effective first-line anticonvulsant that is associated with several side effects including bone marrow suppression and subsequent cytopenia. However, VPA associated myelodysplasia is not a well described entity that can be seen in patients on VPA treatment.

Case Report.

Herein, we describe a 9-year-old female patient with a past medical history of seizure disorder who presented with 3-week history of intermittent fevers, fatigue, weakness, and multiple unexplained bruises. Complete blood count (CBC) was remarkable for marked thrombocytopenia. Trephine biopsy showed a normocellular marrow with maturing trilineage hematopoiesis and scattered atypical megakaryocytes including numerous small hypolobated forms with frequent forms showing separated nuclei. Her CBC showed normalization 7 months after VPA was stopped.

Conclusion.

The presence of bone marrow suppression and myelodysplasia in patients on VPA treatment should be taken into consideration as it can cause a diagnostic pitfall especially in pediatric and elderly populations. A careful review of past medical history and medications can help make the correct diagnosis.