Abstracts

RATIONALE: To describe hematological disturbances in epileptic patients on chronic antiepileptic drug (AED) therapy. METHODS: We evaluated consecutively the charts of all adult out patients in an epilepsy clinic. We divided the patients into the following groups according to AED use: 1, monotherapy with carbamazepine (CBZ); 2, with valproic acid (VPA); 3, association of CBZ and phenobarbital (PB). We reviewed the blood counts of 82 patients and analyzed red, white cells and platelet counts. Anemia was considered when the concentration of hemoglobin was under 12g/dL and 13g/dL, in female and male patients, respectively. Leukopenia (Lp), neutropenia (Np) and thrombocytopenia (Tp) when leukocyte, neutrophil and platelet counts were under 5.000/dL, 1.500/dL, and 140.000/dL, respectively. The frequencies of these abnormalities were compared among the groups using Fisher's exact Test. RESULTS: In group 1, 42 patients were receiving CBZ with doses ranging from 400 to 1.800mg/d (mean 937mg/d), with a mean time of use of 6.9 years (range 1 to 23). Only 3 of these presented microcytic anemia, 9 had Lp, one had Np, and Tp was observed in one patient. In group 2, 20 patients were taking VPA, with doses ranging from 500 to 3.000mg/d (mean 1.200mg/d), with a mean time of use of 4.6 years (range 1-10), none had anemia, 3 had Lp, without Np, and 3, Tp. In group 3, 20 patients were taking CBZ with doses ranging from 400 to 2.000mg/d (mean 1.075mg/d) and PB, 50 to 200mg/d (mean 120 mg/d), with a mean time of use of 6.31 years (range 0.5 to 15). From these only two had Lp and another had microcytic anemia. No patient had clinical symptoms related to these abnormalities. The frequency of anemia and leukopenia did not differ among the groups. Thrombocytopenia was observed more frequent in patients taking VPA in monotherapy, than in patients taking CBZ in monotherapy, or associated with PB (3/20 vs. 1/62, p=0.04). CONCLUSIONS: In this series of 82 adult epileptic patients we observed: 1. low frequency of hematological abnormalities. 2. higher association of thrombocytopenia in patients taking VPA in monotherapy when compared to the others (p=0.04).