A Rare Case of a Dual-Mechanism-Based Thrombocytopenia Secondary to Carbamazepine in an Epileptic Patient

Among antiepileptic drugs, carbamazepine often causes various hematological complications, one of which is thrombocytopenia. Reports of immune-mediated and myelosuppressive pathways being involved separately are common, but cases in which both occur together, known as dual-mechanism thrombocytopenia, are not very common. This case described a 35-year-old lady who had epilepsy and presented with unexplained bleeding and a notable decline in the level of her platelets. A high platelet count was found in the peripheral blood, and fewer megakaryocytes were seen in the bone marrow, indicating destruction of platelets in the bloodstream as well as underproduction in the bone marrow. Once carbamazepine was stopped, healthy blood counts came back quickly, indicating a certain connection. It demonstrated that monitoring platelets is important for those on carbamazepine therapy for a long time and that a dual cause should be considered for unexplained or severe low platelet counts.