Catastrophic Presentation of Sodium Valproate Induced Pure Red Cell Aplasia in a Child with Absence Seizure

Sodium valproate is an effective antiepileptic drug used as monotherapy or adjuvant/alternative with other antiepileptic drugs. Haematological toxicity of this drug, though rare, is now an established fact and comprises mainly of neutropenia, thrombocytopenia and aplastic anemia. Very few cases of Pure Red Cell Aplasia (PRCA) following valproate therapy were reported in last 35 years but none presented as acute emergency. We report a case of a 7-year-old child suffering from absence seizure who developed features of acute heart failure due to anemia after 2 months of sodium valproate monotherapy. No underlying haematological or cardiological cause was found. Bone marrow study showed evidence of PRCA. After discontinuation of the drug patient improved gradually and never relapsed again. This case highlights the importance of haematological evaluation both clinically and by laboratory investigation during follow up visits after starting sodium valproate therapy.