Meds and Blood Cell Counts
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Meds and Blood Cell Counts?

Q: First, I would also like to thank you for providing this needed service to our website! I'm a nurse in a local nursing home and diagnosed with BP for 19 years. I'm on depakote 1000mg daily and lithium 600mg daily...recently my blood count showed an increase in monocytes and a decrease in lymphocytes...when is it time to worry about changes in the WBC count?

Thanks in advance-Kathy

Dear Kathy -- 

You're welcome.  This is a great way for me to push my education along too.  Your question goes beyond what I know, I
suspect to what is not known.  Namely, there are some basic changes in blood counts we expect from these medications:
lithium raises the total white cell count, and Depakote can lower platelet counts.  Beyond that, exactly what happens to
individual cell lines within the white cell group (e.g. monocytes and lymphocytes), I've never seen reports nor any significance to those as far as risk (send me back something if you learn so).  Rarely many medications can lower counts, and carbamazepine is famous for this as you know.  But medications that do that are far more like to do so in the first 6 months of use; this rare problem (except with carbamazepine and clozapine) becomes even more rare after that.  And what cell changes might precede it to warn you?  Never heard anything about that.  You might try asking a hematologist if there's a "ask the doc" program in that field out there somewhere?

Dr. Phelps

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