[Aplastic anemia in carbamazepine therapy]

We report a case of carbamazepine-induced aplastic anemia. After an initial treatment period of 10 days (600 mg/day), moderate, persisting pancytopenia was observed. Three years later, carbamazepine treatment was resumed at 400 mg/day for 120 days. Subsequently, more severe, irreversible pancytopenia due to bone marrow aplasia was diagnosed. History, course, bone marrow findings and the extensive, negative work-up for other causes of aplastic anemia strongly indicate that carbamazepine was etiologically responsible. Aplastic anemia secondary to carbamazepine treatment is rarely reported. Information on the dose and time of exposure are only available from anecdotal case reports. Based on a literature survey we analyze the risk of this potentially lethal hematological side-effect and make recommendations for routine blood checks.