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Anemia Secondary to Valproic Acid in a Female Patient with Schizoaffective Disorder

Chen-Yu Wang, Ching-Ming Cheng, Ming-Shun Chung

A 38-year-old single woman patient with a diagnosis of schizoaffective disorder was admitted to a psychiatric acute ward through emergency department. She was diagnosed as schizophrenia with mood symptoms when she was 30-year-old in a medical center. She presented herself with manic symptoms, auditory hallucination, persecutory delusion, reference delusion, and thought broadcasting during the hospitalization course. Valproic acid (VPA) was prescribed due to prominent manic symptoms including irritabity, hypertalkativeness, hyperactivity, impulsivity, distractibility, and grandiosity since admission. The psychotic symptoms remained after multiple antipsychotic medication treatment. Clozapine was considered and total blood count was checked before initiating the treatment. The result showed a newly found normocytic anemia, with hemoglobin (Hb) 8.9 g/dL, hematocrit (HCT) 28.4%, and mean cell volume (MCV) 88.2 fL, which were 12.7 g/dL, 39%, and 87.8 fL at admission. We traced her medical record and found the Hb was 11.6 g/dL six months ago. She also denied any history of anemia, and was not in her menstrual period.
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Editorial Committe, Taiwanese Journal of Psychiatry
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