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

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.