[A man in his 30s with psychosis and neutropenia]

Abnormal blood test results are common in both primary and specialist health care. The cause is often multifactorial, and investigations are often conducted across various specialties. We present a patient with incidental disturbances in the blood count with a serious causal relationship.

A young man with Asperger's syndrome and epilepsy sought emergency care due to physical and mental distress following several epileptic seizures after drinking alcohol a few days prior. His physical examination was unremarkable, but blood tests showed severe neutropenia, mild anaemia and thrombocytopenia. The patient was admitted to a psychiatric ward with delusions.

Patients with Asperger's syndrome and epilepsy are at higher risk of psychosis. On admission, the patient's delusions improved with increased olanzapine dosage, after which the medication was discontinued due to severe neutropenia. Discontinuation of olanzapine and supplementary vitamin injections did not improve the blood count. Further investigations raised suspicion of a primary bone marrow disorder. After further investigation, including a bone marrow examination, acute lymphoblastic leukaemia (ALL) was diagnosed. The case highlights the importance of thoroughly investigating serious haematologic abnormalities. It also raises questions about the potential role of long-term antiepileptic medication exposure in the development of leukaemia, which warrants further research.