Depakine Induced Pseudo-Pelger-Huet Anomaly

Pelger-Huët anomaly is a rare benign autosomaldominant anomaly with incidence of about 1 in 6000 persons. Pelger-Huët cells are morphologically abnormal neutrophils that are either bilobed or completely unsegmented.1,2 It should be differentiated from acquired or pseudo-Pelger-Huët anomaly (PPHA), which has similar morphology and association with different pathological states like myelodysplasia, Acute myeloid leukemia (AML), chronic myelogenous leukemia (CML) as well as with certain infections and drugs (Valproate and Ibuprofen). An 18-year-old woman who was a case of mental retardation since early childhood was admitted with episodes of epistaxis and pancytopenia. She had a history of end stage renal disease on chronic intermittent dialysis and history of seizure on sodium valproate and nitrazepam. Since 1 month ago valproate dosage was increased from 200 mg twice a day to 500 mg twice a day. Physical examination showed pallor, and inability to speak and follow orders. There was no lymphadenopathy and organomegaly. Laboratory findings showed WBC: 3300/µL, Hb: 6 gr/dl, Platelet: 45000/µL, Creatinine: 7 mg/dL. Peripheral blood smear showed many bi-lobed neutrophils (pseudo pelger huet cells)...