Factor XIII deficiency associated with valproate treatment

Area of Science:

• Pediatric Hematology
• Pharmacology
• Clinical Toxicology

Background:

• Valproate (VPA) is a widely used anticonvulsant and mood-stabilizing medication.
• Coagulation disorders are potential adverse effects of certain medications.
• Factor XIII deficiency is a rare bleeding disorder affecting hemostasis.

Observation:

• Two pediatric cases of factor XIII deficiency developed during valproate treatment are presented.
• Patients exhibited recurrent epistaxis as the primary clinical manifestation.
• Associated coagulation abnormalities included thrombocytopenia and decreased von Willebrand factor levels.

Findings:

• Factor XIII deficiency resolved upon reduction or discontinuation of valproate therapy.
• Valproate may impact hepatic synthetic function and megakaryocyte activity, potentially affecting factor XIII levels.
• The study suggests a causal or aggravating role of valproate in factor XIII deficiency.

Implications:

• Bleeding symptoms in children on valproate may indicate an acquired factor XIII deficiency.
• Pre-operative assessment of factor XIII activity is recommended for patients undergoing surgery while on valproate.
• This highlights the importance of recognizing drug-induced coagulation disorders for patient safety.