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Hematological Consequences of Valproic Acid in Pediatric Patients: A Systematic Review with a Mechanistic Approach

Bamdad Riahi-Zanjani1, Mohammad Delirrad2, Rana Fazeli-Bakhtiyari1

  • 1Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

CNS & Neurological Disorders Drug Targets
|August 12, 2021
PubMed

Insights

Valproate (VPA) can cause serious hematotoxicity in children, including neutropenia and thrombocytopenia. Monitoring blood counts during VPA therapy is recommended, and combining VPA with antioxidants may reduce these pediatric hematologic side effects.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Toxicology

Background:

  • Valproate (VPA) is an effective anti-seizure medication with known hematological risks.
  • Pediatric patients are particularly vulnerable to VPA-induced hematotoxicity due to their developing systems and increased leukemia risk.

Purpose of the Study:

  • To systematically review existing literature on the hematological consequences of Valproate (VPA) therapy in pediatric patients.
  • To establish a conclusive understanding of VPA's hematotoxicity in children.

Main Methods:

  • A systematic literature search was conducted in June 2021 using keywords like "hematotoxicity", "valproic acid", and "pediatrics".
  • Original research articles focusing on the association between VPA therapy and hematotoxicity in pediatric populations were included.
  • Data from 36 articles, encompassing 1381 patients, were qualitatively analyzed.

Main Results:

  • Valproate (VPA) therapy was found to cause significant hematotoxicity in children, even at prescribed doses.
  • Common complications include neutropenia, thrombocytopenia, and bone marrow depression.
  • Hematological parameters improved within two weeks upon VPA discontinuation or dose reduction, with or without alternative antiepileptic drugs.

Conclusions:

  • Valproate (VPA) therapy poses a risk of hematotoxicity in pediatric patients, necessitating regular monitoring of blood counts.
  • Exploring mechanistic pathways suggests that combining VPA with antioxidants could potentially mitigate these adverse hematological effects.
Abstract

Keywords:
Valproic acidchildrenhematological consequenceshematotoxicitypediatric patientsvalproate (VPA)

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