Lithium hematologic

The hematological change most frequently detected in patients taking lithium is leukocytosis (approximately 15,000 white blood cells/mm ). This change is generally benign and reversible. 

As part of the standard prelithium workup, a thorough medical evaluation should be completed. Table 10-5 lists the various laboratory tests recommended to assess overall physical status, especially renal, thyroid, hematological, and cardiac function, before initiation of treatment. In particular, the renal and the thyroid systems require a baseline assessment and periodic reevaluation with maintenance or prophylactic lithium tnerapy. 

Carbamazepine. The anticonvulsant carbamazepine was actually the first to be shown to be effective in the manic phase of bipolar disorder, but it has not been approved for this use by regulatory authorities such as the U.S. Food and Drug Administration (FDA). Its mechanism of action may be to enhance GABA function, perhaps in part by actions on sodium and/or potassium channels (Fig. 7—24). Because its efficacy is less well documented and its side effects can include sedation and hematological abnormalities, it is not as well accepted for first-line use in the treatment of mood disorders as either lithium or valproic acid. 

Hematologic Lithium increases bone marrow neutrophil production, protects bone marrow hemopoietic stem cells after exposure to anticancer drugs or radiation, and increases platelet count [71 ]. These effects suggest several potential uses in medicine, such as concomitant use in patients who have clozapine-induced neutropenia. 

Focosi D, Azzara A, Kast RE, Carulli G, Petrini M. Lithium and hematology established and proposed uses. J Leukocyte Biol 2009 85(1) 20-8. 

Immunologic Leukocytosis. A case is described of a 23-year-old man with paranoid schizophrenia who had previously developed clozapine-induced leukopenia, and who presented with olanzapine-associated leukopenia and thrombocytopenia, in which treatment with lithium at 600mg/day, allowed olanzapine to be restarted without recurrence of hematologic abnormalities [115 ]. 

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