[DrLANC]

12 year old child with a history of severe seizure disorder that does not respond to typical anti-seizure medication protocol, he has been on a new seizure medication for 6 weeks and presents with fatigue, headache and nosebleeds. The blood smear yields pancytopenia.



What condition does this patient have? What was the cause? What anti-seizure medication is he on?
Let me know!

 

[indian]

He carbamazepine which causes pancytopenia
the blood film showing increased RBC pallor and absent platelets.

 

[khanar]

The blood film is showing macrocytosis, thrombocytopenia, which are typical of bone marrow suppression which can be seen with many antiepileptics but mainly phenytoin, carbamazepine.

 

[DrLANC]

Answer

Unfortunately you are both incorrect. I will point these clues out, seizure disorder that does not respond to typical anti-seizure medication protocol, he has been on a new seizure medication for 6 weeks.

The child does have Aplastic Anemia, and it is due to Felbamate.
His seizures do not respond to typical anti-seizure medication, that should include Carbamazepine, Phenytoin, Valproic Acid. Felbamate is considered to be an absolute last choice when all typical anti-seizure meds don't work and even then you have to evaluate the risk-benefit since Felbamate can cause Hepatotoxicity and Aplastic Anemia.