[Coagulopathy and anemia caused by anticonvulsants]

Long-term antiepileptic polytherapy regularly induces some slight impairment of haemostasis without clinical manifestations, but serious clinical disorders may appear, even in the absence of over-dosage. In the case reported here the patient was undergoing surgery for correction of scoliosis. Preoperative laboratory tests only showed a slight decrease of fibrinogen and a moderate lengthening of thrombin time; there was no anaemia. Immediately after the incision a severe haemorrhagic syndrome occurred. It was treated with a massive transfusion and administration of some blood coagulation factors, but bleeding was so profuse that surgery was abandoned. Later, the patient developed acute thrombocytopenia, progressive decrease of Quick time and of plasma blood coagulation factors, and anaemia due to folate deficiency. Awareness of these disorders should lead to prophylactic measures.