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Dose-Related Thrombocytopenia and Macrocytic Anemia Associated With Valproate Use in Bipolar Disorder

J Clin Psychiatry 1997;58(3):125 [letter]

Letter to the Editor

Sir: A recent report on hematologic effects of anticonvulsants used for treating psychiatric inpatients showed a total absence of drug-related thrombocytopenia and anemia in 1251 patients treated with valproate. In contradistinction, various authors report low platelet counts in adults and children treated for seizures and other neurologic disorders with valproate. One study found a mean reduction in platelet count of 49,000/µL below baseline at doses near 1500 mg/day of valproate and of 69,000/µL at doses near 2800 mg/day. Since thrombocytopenia has not been reported in a psychiatric population treated with valproate, I report a case of a patient with bipolar I disorder who developed thrombocytopenia and anemia associated with valproate treatment.