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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.

Aplastic-Anemia-Pancytopenia-and-macrocytes-40x-website[1].jpg

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

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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.
 

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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.
 
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