Carbamazepine-Induced Hemolytic and Aplastic Crises Associated with Reduced Glutathione Peroxidase Activity of Erythrocytes


Although pure red cell aplasia is a well-known side effect of carbamazepine treatment, intravascular hemolytic anemia is rare. We describe a 5-year-old boy who developed concurrent intravascular hemolytic anemia and erythroblastopenia, probably due to carbamazepine. Carbamazepine treatment was subsequently discontinued, and the patient was treated with red blood cell transfusions, haptoglobin, and methylprednisolone. His hematologic abnormalities were almost fully recovered within 2 weeks. Examination of the patient’s and mother’s erythrocyte enzyme activities revealed mildly decreased erythrocyte glutathione peroxidase (GSH-Px) activity. We speculate that patients with reduced GSH-Px activity are at a high risk of developing carbamazepine-induced hemolytic crisis and/or aplastic crisis.

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Correspondence to Masaki Yamamoto or Nobuhiro Suzuki or Naoki Hatakeyama or Noriaki Kubo or Nobutada Tachi or Hitoshi Kanno or Hisaichi Fujii or Hiroyuki Tsutsumi.

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Yamamoto, M., Suzuki, N., Hatakeyama, N. et al. Carbamazepine-Induced Hemolytic and Aplastic Crises Associated with Reduced Glutathione Peroxidase Activity of Erythrocytes. Int J Hematol 86, 325–328 (2007).

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Key words

  • Intravascular hemolytic anemia
  • Hemolytic crisis
  • Aplastic crisis
  • Reduced glutathione peroxidase activity
  • Carbamazepine