Do antiepileptic drugs have any effect on Neutrophil / Lymphocyte and Platelet / Lymphocyte Ratio?
Main Article Content
Objective: The aim of this study was to compare the complete blood count values of 40 healthy individuals and 60 patients who are using antiepileptic drugs (AEDs), specifically to evaluate neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and basophil-lymphocyte ratio (BLR). This study is important because it is the first study on hematological parameters such as NLR, MLO, PLO and BLO.
Material and Methods: In this study, hemogram and biochemical data of 17 patients who received carbamazepine (CBZ), 21 patients with valproic acid (VPA), 22 patients with levetiracetam (LEV) along with 40 healthy controls were gathered and compared. The differences between the groups were evaluated statistically.
Results: No difference was present between the groups in terms of age or gender (p> 0.05). NLR was 2.19±1.42 for patients using CBZ, 1.64±1.34 for VPA users, 2.18±0.73 for LEV users and 2.04±0.85 for control group (p> 0.05). NLR, MLR, PLR and BLR were not significantly different from the control group.
Conclusion: To our knowledge, no study has targeted the haematological effects of antiepileptics on NLR, MLR, PLR and BLR. This study was important because it is the first study the effect of various antiepileptics on the hematological parameters such as NLR, MLR, PLR, and BLR. We believe that our study will articulate new studies.
2. Perucca E, Meador KJ. Adverse effects of antiepileptic drugs. Acta Neurol Scand Suppl 2005; 181: 30-35.
3. Perucca P, Gilliam FG. Adverse effects of antiepileptic drugs. Lancet Neurol. 2012 Sep; 11(9): 792-802.
4. Glauser TA, Graves NM. Phenytoin and fosphenytoin, In: Wyllie E, editor. The treatment of epilepsy principles and practice. 3rd ed., Philadelphia: Lippincott, Williams & Wilkins; 2001. p. 853-869.
5. Balfour AJ. Valproicacid a review of its pharmacology and therapeutic potential in indications other than epilepsy. CNS Drugs 1994; 2(2): 144-173.
6. Bunnell K. & Pucci F. Levetiracetam-induced neutropenia following traumatic brain injury. Brain Inj, 2015; 29(1): 115- 117.
7. Suwalsky M, Mennickent S, Norris B, Villena F, Sotomayor CP. Effects of the antiepileptic drug carbamazepine on human erythrocytes. Toxicol In Vitro. 2006 Dec; 20(8): 1363-1369.
8. Bayazıt EO, Nar C. Carbamazepine hypersensitivity syndrome. TÜRKDERM 2002; 36: 125-128.
9. Orum MH, Kara MZ, Egilmez OB, Kalenderoglu A. Complete blood count alterations due to the opioid use: what about the lymphocyte-related ratios, especially in monocyte to lymphocyte ratio and platelet to lymphocyte ratio?. J Immunoassay Immunochem 2018; 14: 1-12.
10. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB, Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005; 45: 1638-1643.
11. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of un selected out patients. Arch Pathol Lab Med 2009; 133: 628-632.
12. Orum MH, Kara MZ, Egilmez OB. Relationship between immune cells and alcohol dependents and controls: what about the lymphocyte-related ratios? J Immunoassay Immunochem 2018; 39(3): 348-350.
13. Orum MH, Kara MZ, Egilmez OB. Mean platelet volume and neutrophil to lymphocyte ratio as parameters to indicate the severity of suicide attempt. J Immunoassay Immunochem 2018; 39(6): 647-659.
14. Deveci Ş, Çelebi A, Aşkın S, Gürsoy AE, Kolukısa M, Hakyemez A. Relationship of mean platelet volume to an acute ischemic stroke. Ege Journal of Medicine 2014; 53(1): 1-6.
15. Arıkanoğlu A, Cevik MU, Uzar E, Acar A, Akıl E, Ekici F, Taşdemir N. The Increase of the Mean Platelet Volume in Patients With Intracerebral Haemorrhage. Turkish Journal of Neurology 2012; 18: 54-56.
16. Medina KL. Overview of the Immune System. Handb. Clin. Neurol. 2016; 133: 61-76.
17. Guzel D, Yazici AB, Yazici E, Erol A. Alterations of the HematologicCells in Synthetic Cannabinoid Users. J. Clin. Lab. Anal. 2017; 31: 6.
18. Qi Y, Zhang Y, Fu X, Wang A, Yang, Y, Shang Y, Gao Q. Platelet-to-lymphocyteratio in peripheral blood: A Novel Independent Prognostic Factor in Patients with Melanoma. Int. Immuno pharmacol. 2018; 56: 143-147.
19. Orum MH, Kalenderoglu A, Egilmez OB, Ozen ME, Kapici Y. Hyponatremia associated with repeated use of sodium valproate. Psychiatry and Behavioral Sciences 2018; 8(2): 93-94.
20. Fellows WR. A case of aplastic anemia and pancytopenia with tegretol therapy. Headache. 1969; 9(1): 92-95.
21. Verrotti A, Scaparrotta A, Grosso S, Chiarelli F, Coppola G. Anticonvulsant drug sand hematological disease. Neurol Sci. 2014; 35: 983-993.
22. Thorsten G, Martin T, Nellie B, Elke L. Valproate-associated coagülopathies are frequent and variable in children.2007; XXIst İSTH Congress.
23. Banarjea MC, Diener W Kutschke G. Pro- and anticoagulatory factors under sodium valproate-therapy in children: Neuro pediatrics. 2002 Aug; 33(4): 215-220.
24. Cannizzaro E, Albisetti M, Wohlrab G, Shmugge M. Severe bleeding complications: Neuro pediatrics. 2007; 38: 42-45.
25. Pedersen-Bjergaard U, Andersen M, Hansen PB. Drugspecific characteristics of thrombocytopenia caused by non-cytotoxic drugs. Eur. J. Clin. Pharmacol. 1998; 54: 9-10.
26. Owens CW, Parker NE, Nunn PP, Davies J. Agranulocytosis associated with carbamazepine, and a positive reaction with anti-lymphoid leukaemia antiserum during recovery. Postgraduate Med J. 1980; 56: 665-668.
27. Pellock JM. Carbamazepine side effects in children and adults. Epilepsia. 1987; 28 Suppl 3: S64-70.
28. Kumar R, Chivukula S, Katukuri GR, Chandrasekhar UK, Shivashankar KN. Carbamazepine Induced Thrombocytopenia. J Clin Diagn Res. 2017 Sep; 11(9): OD12-OD13.
29. Mushiroda T, Takahashi Y, Onuma T, Yamamoto Y, Kamei T, Hoshida T. Association of HLA-A*31:01 Screening With the Incidence of Carbamazepine-Induced Cutaneous Adverse Reactions in a Japanese Population. JAMA Neurol. 2018; 75(7): 842-849.
30. U.S. Food and Drug Administration. Keppra (levetiracetam) tablets and oral solution. (Cited5August2016).http://www.fda.gow/Safety/MedWatch/SafetyInformation/ucm284241.htm
31. Tohen M, Castillo J, Baldessarini RJ, Zarate C Jr, Kando JC. Blood dyscrasias with carbamazepine and valproate: A pharmaco epidemiological study of 2228 patients at risk. Am. J. Psychiatry 1995; 152: 413–418.
32. Taberner Bonastre MT, Peralta Muñoz S, Boza FM, Gumà I, Padró J. Neutropenia secondary to exposure to levetiracetam. Tumori. 2015 Sep 9;101(5):e145-6. doi: 10.5301/tj.5000312.
33. Jayendra R. Gohil, Tushar S. Agarwal. Levetiracetam Adverse Drug Reaction: Pancytopenia. J Pediatr Neurosci 2018; 13: 116-117.
34. Alzahrani T, Kay D, Alqahtani SA, Makke Y, Lesky L, Koubeissi MZ. Levetiracetam-induced pancytopenia. Epilepsy Behav Case Rep 2015; 4: 45-47.