Affiliations: Department of Pediatrics, Shiraz Medical School,
Shiraz, Iran
Note: [] Correspondence: Ali A. Asadi-Pooya, MD, Department of
Pediatrics, Nemazee Hospital, Shiraz, Iran. Tel./Fax: +98 711 6265024; E-mail:
[email protected]
Abstract: Carbamazepine (CBZ) is a commonly used anticonvulsant agent, but it
has been linked with different blood cell abnormalities. This study tried to
determine some of the risk factors associated with CBZ-induced leukopenia in
pediatric and adolescent age group. This nested-cohort study was conducted on
children and adolescents with epilepsy who received CBZ monotherapy. They
included 41 patients with epilepsy. From all of the patients, baseline blood
tests were obtained before starting medication and then serially. The patients
were followed for at least one year. Thirteen patients (31.7%) developed
leukopenia in follow-up blood tests. In one patient CBZ was discontinued after
six months due to the occurrence of significant neutropenia. Four factors were
associated with CBZ-induced leukopenia in these patients. The first factor was
gender; leukopenia was more common among girls (P=0.018).
The other factors were lower white blood cell counts, lower neutrophil counts
and lower monocyte counts in the first complete blood count, before starting
CBZ. It is very important to have a complete blood cell count in everyone
before treatment with CBZ is started. Thereafter, the frequency of blood
monitoring can be determined on an individual basis. It is reasonable to be
very careful and follow the patient repeatedly and closely when deciding to
start CBZ in a girl with borderline low white blood cells, neutrophil or
monocyte count.