Li Chen, Su Lei, Lao Minxi, Zhu Shaofang, Ding Meilin
Department of Geriatrics.
Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Medicine (Baltimore). 2018 Dec;97(50):e13626. doi: 10.1097/MD.0000000000013626.
Sodium valproate is a widely used antiepileptic drug and also used to prevent postoperative seizures in neurosurgery. Anemia caused by sodium valproate is occasionally reported and most are from pediatric patients.
We present the case of a 79-year-old man who developed anemia in the setting of a short-term sodium valproate therapy for the prevention of postoperative seizures.
By testing complete blood count we found anemia and hepatic enzyme elevations arising after 3-week standard dose sodium valproate therapy for preventing postoperative seizures. Our investigations ruled out most of the known causes of anemia including infection, uncontrolled bleeding, underlying systemic disease, malnutrition, immune hemolytic anemia, and neoplasia. On the drug's discontinuation as diagnostic therapy the patient's hemoglobin began to rise spontaneously and liver function returned to normal. Thus anemia secondary to sodium valproate was considered as the most likely diagnosis.
Sodium valproate was suspended and the patient was transfused with concentrated red blood cells.
The hemoglobin recovered obviously on the drug's discontinuation.
Hematologic toxicity of sodium valproate can occur quickly. Regular complete blood count test helps to make prompt diagnosis and drug discontinuation leads to the recovery.
丙戊酸钠是一种广泛使用的抗癫痫药物，也用于预防神经外科手术后的癫痫发作。偶尔有丙戊酸钠引起贫血的报道，且大多数来自儿科患者。
我们报告一例79岁男性患者，在短期使用丙戊酸钠预防术后癫痫发作的过程中出现贫血。
通过检测全血细胞计数，我们发现患者在接受为期3周的标准剂量丙戊酸钠预防术后癫痫发作治疗后出现贫血和肝酶升高。我们的调查排除了大多数已知的贫血原因，包括感染、未控制的出血、潜在的全身性疾病、营养不良、免疫性溶血性贫血和肿瘤。在停用该药物作为诊断性治疗后，患者的血红蛋白开始自发上升，肝功能恢复正常。因此，丙戊酸钠继发的贫血被认为是最可能的诊断。
停用丙戊酸钠，并给患者输注浓缩红细胞。
停药后血红蛋白明显恢复。
丙戊酸钠的血液学毒性可能迅速发生。定期进行全血细胞计数检查有助于及时诊断，停药可促使恢复。
