Hematologic manifestations and impaired liver synthetic function during valproate monotherapy

Area of Science:

• Pediatric Neurology
• Clinical Chemistry
• Hematology

Background:

• Epilepsy is a common neurological disorder in children.
• Antiepileptic drugs (AEDs) are crucial for managing seizures.
• Valproate (VPA) is a widely used AED, but its systemic effects require monitoring.

Purpose of the Study:

• To prospectively evaluate the effects of valproate monotherapy on laboratory parameters in children with new-onset epilepsy.
• To assess changes in complete blood count, liver function tests, coagulation profiles, and vitamin levels during VPA treatment.

Main Methods:

• Prospective study of 50 children with new-onset epilepsy commencing valproate therapy.
• Routine laboratory screening (CBC, serum protein, albumin, liver enzymes, coagulation) performed before and at 3, 6, 9 weeks post-treatment.
• Serum vitamin B12 and folate levels measured in 29 patients.

Main Results:

• Significant reduction in red blood cell and platelet counts; increased mean corpuscular volume (MCV).
• Elevated vitamin B12 levels observed.
• Transient reduction in alanine aminotransferase (ALT); significant decrease in serum protein and albumin; decreased serum fibrinogen and increased thrombin time.

Conclusions:

• Valproate therapy may exert a direct toxic effect on hematopoietic stem cells, indicated by altered blood counts.
• Reduced protein, albumin, and fibrinogen suggest impaired liver synthetic function in children on VPA monotherapy.
• These laboratory changes highlight the need for vigilant monitoring in pediatric patients receiving valproate.