skip to main content

Valproate – Thrombocytopenia — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

EasyEpilepsy & Seizure DisordersValproate – ThrombocytopeniaSCE Neurology

A 55-year-old man with known epilepsy on valproate has a routine blood test showing thrombocytopenia (platelets 90 × 10⁹/L). His previous count was normal. He has no bleeding symptoms. What is the most likely cause?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Valproate-induced thrombocytopenia — a dose-dependent adverse effect occurring in approximately 5–10% of patients, caused by direct bone marrow suppression and impaired platelet aggregation

Valproate causes dose-dependent thrombocytopenia in ~5–10% of patients through direct bone marrow suppression and impaired platelet aggregation. It is usually mild-moderate and asymptomatic. Management: check the dose, consider dose reduction if possible, monitor FBC regularly. If platelets drop below 50 × 10⁹/L or there are bleeding symptoms, valproate dose should be reduced or the drug stopped. Pre-operative FBC and coagulation are essential in patients on valproate. A: Temporal relationship to valproate points to drug cause. C: No evidence of liver disease. D: No other DIC features. E: No blast cells.

Reference: BNF – Valproate; NICE NG217