Drug-induced Thrombocytopenia: Pediatric Cases from the Medical Literature

Marcia L. Buck, Pharm.D., FCCP, FPPAG

Disclosures

Pediatr Pharm. 2010;16(11) 

In This Article

Antiepileptic Drugs

Several antiepileptic drugs have been associated with DITP. Valproic acid is one of the more frequently reported causes. In 2008, Nasreddine and Beydoun conducted a prospective, multi-center, double-blinded trial to evaluate the effect of high versus low trough valproic acid concentrations on platelet count.[12] They assessed a total of 851 valproic acid concentrations and concomitant platelet counts from 265 patients between 10 and 75 years of age. Seventeen percent of the patients experienced at least one period of thrombocytopenia. The probability of developing thrombocytopenia was strongly correlated with trough values. None of the patients experienced severe bleeding, but 5% withdrew due to thrombocytopenia. All patients recovered after discontinuation or dose reduction. The dose-response relationship and the ability of some patients to tolerate resuming treatment suggest that this may not be an immune-mediated form of DITP.

Although previously reported in only a few adults, levetiracetam-induced thrombocytopenia was recently described in a 6-year-old child.[13] The patient had been placed on levetiracetam for seizures associated with a cerebral venous thrombosis. Five weeks after starting therapy, he developed petechiae on the skin and mucosa. Other than thrombocytopenia, laboratory studies were unremarkable. Bone marrow aspiration revealed only increased megakaryocytes. As no other causative agents appeared likely, levetiracetam was discontinued. Within days, the platelet count began to increase and normalized 4 weeks after discontinuation.

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