Successful reintroduction of valproic acid after the occurrence of pancytopenia.

BACKGROUND

Valproic acid is associated with a variety of hematologic abnormalities, most commonly thrombocytopenia. Pancytopenia is much less common and potentially much more serious. Little is known about the natural course of valproate-induced pancytopenia.

CASE SUMMARY: We present a patient who developed pancytopenia while taking valproic acid for bipolar illness. After failing to respond to several other mood stabilizers, valproic acid was cautiously reintroduced with close hematologic monitoring. The pancytopenia has not recurred in the past 6 months.

CONCLUSIONS

Pancytopenia may not represent an absolute contraindication to continuing valproate therapy, although caution is warranted.