A retrospective study was conducted on pediatric charts (age <22 years at time of initiation) from 2010-2019. N=129 charts were screened for having been seen by a Registered Dietitian in the epilepsy clinic. After initial screen, further charts were excluded as there was unclear documentation that they ever started dietary therapy (N=50). Individuals from this center were on ketogenic diet, Modified Atkins diet, or low glycemic index diet, with varying levels of compliance. In total, 79 charts were reviewed for CBC results and additional lab trends.

Out of 79 pediatric patients who started on one of the ketogenic diet therapies, 12 patients were found to be leukopenic after diet initiation. 11 of 12 patients had a pre-diet CBC available for comparison. All patients with available pre-diet bloodwork were noted to have a decrease in leukocytes after diet initiation. None of the patients who developed leukopenia required extra precautions/changes in management. All 6 out of 12 patients who have been since weaned off diet have had improvement/normalization of labs.

Routine labwork remains a key component of ketogenic diet monitoring. The population studied showed that 15% of patients demonstrated leukopenia as a direct result of the ketogenic diet.Development of leukopenia after diet initiation may lead to further testing/medical follow-up that does not necessarily warrant medical intervention. Further review of current practice guidelines is needed to determine the cost/benefit analysis of specific laboratory panels if no intervention is performed.