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Factor XIII deficiency associated with valproate treatment.
Martin Teich1, Elke Longin, Carl-Erik Dempfle
1Department of Pediatrics, Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany. martin.teich@kikli.ma.uni-heidelberg.de
Epilepsia
|January 24, 2004
Summary
Valproate (VPA) treatment in children can lead to factor XIII deficiency, causing bleeding issues like epistaxis. Monitoring factor XIII activity is crucial before surgery in patients on VPA.
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.