Pure Red Cell Aplasia after 13 Years of Sodium Valproate, and Bone Marrow Suppression after 17 Years of Carbamazepine 英文参考文献.docVIP

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Pure Red Cell Aplasia after 13 Years of Sodium Valproate, and Bone Marrow Suppression after 17 Years of Carbamazepine 英文参考文献.doc

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Pure Red Cell Aplasia after 13 Years of Sodium Valproate, and Bone Marrow Suppression after 17 Years of Carbamazepine 英文参考文献

o Openaccess,freelyavailableonline PL S MEDICINE CaseReport PureRedCellAplasiaafter13Years ofSodiumValproate,andBoneMarrow Suppressionafter17YearsofCarbamazepine Tiong The1*,Ratnavalli Kolla2,Fitzroy Dawkins2,Annapurni Jayam Trouth2 Casereportfrom1SaintPeter’sUniversityHospital,NewBrunswick,NewJersey,UnitedStatesofAmerica, 2HowardUniversityHospital,Washington,DistrictofColumia, UnitedStatesofAmerica CompetingInterests:Theauthors havedeclaredthatnocompeting interestsexist. PRESENTATIONofCASE cells or megaloblastic changes. Cytogenetic study showed a Robertsonian (i.e., of the whole arms) translocation of Chromosome 14 and 21 involving the long arm of Chromosome 21. Except for mild adrenal insufficiency noted on an adrenocortico- tropichormonestimulationtest,allhertests, includingviralandimmunologicalinvestiga- tions to identify known causes of aplastic anemia,werenegative.Thepatient’sthyroid function tests were normal. She was started on low-dose hydrocortisone for her adrenal insufficiency and megestrol acetate to in- creaseherappetite. The patient’s carbamazepine was discon- tinued.Within10d,herWBChadrisento6.7 3106/landherplateletcountto2483106/l. Serial complete blood counts showed wor- seninganemiaoverthenext15wk,requiring two packed red blood cell transfusions at week 6 and week 14, when her Hb was 31 and 53 g/l, respectively. Throughout this period, her reticulocyte count was low, at about0.18%(normalrange0.5%–2%),while herWBCandplateletcountwerenormal.We made a diagnosis of pure red cell aplasia (PRCA).Asecondbonemarrowbiopsyunder minimallyconscioussedationwasunsuccess- ful, and the patient declined further at- tempts. After the first transfusion she was startedonprednisoneanderythropoietinfor her PRCA. Meanwhile, because of her wor- sening seizures, we increased her sodium valproate dose, increasing her serum val- proatelevelfrom70mcg/mlto110mcg/ml. After the second transfusion, we discontin- uedhersodiumvalproateandstartedheron clonazepaman