Carbamazepine
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Carbamazepine Haemolytic anaemia The day after a biparietal parasagittal craniotomy for excision 01 a meningioma, a 61-year-old man began laking phenytoin 1QOmg qid for seizure prophylaxis . He had received 4 units 01 whole blood during his operation. Haemoglobin levels were 15 .0 gjdl preoperatively, 12.6 9/dl one day after and 10.2 g/dl five days afler surgery. A subgaleal effusion responsive to spinal taps and flap aspiration was fallowed by tever and eosinophilia. Thus, on Ihe eighteenth postoperative day, carbamazepine 100mg tid was given instead of phenytoin and fever resolved quickly. Haemoglobin was 11.3 gfdf. After 20 days' therapy with carbamazepine the patient developed fatigue, dark urine and yellow sclerae and consulted another doctor. Haemoglobin was now 7.6 g/dl, leucocyte count was 5.7 x 10 9 /L, direct and indirect Coombs tests were negative and reticulocytes were 1.9%. Serum lactic dehydrogenase was 1820 U/l and bilirubin 3.2 mg/dl. Free haemoglobin and protein 2 + were present in urine, A transfusion of 3 units of packed red blood cells was given and carbamazepine discontinued. Four days later the patient returned to the inilial inslltulion with symptoms already much improved. laboratory findings were: haemoglobin 9.6 g/dl,; leucocyte count 7.8 x 10 9 /L ; mean cell volume 85.711 ; platelet count 264 x 10 9 /L; reticulocytes 8.1 % and serum lotal bilirubin concentration 1.2 mgjdl. Serum lactic dehydrogenase was 4 times the normal value and aspartate aminotransferase was slightly elevated. Direct Coombs lest and antibody screening were negative. The patient was discharged. Seven months later haemoglobin was 15.1 g/dl, leucocyte count 6.0 X 10 9 /L and reticulocyles were 1%_ Direcl Coombs test was negative and red cell glucose-6·phosphate dehydrogenase normal. Laboratory findings and rapid recovery following cessation of carbamazepine do not support a diagnosis of hepatitis for this patient. Negative Coombs tests and antibody screening plus the 5·week delay after surgery before the reaction occurred make a delayed haemolytic transfusion reaction unlikely A rare but potentially dangerous adverse reaction to carbamazepine is suspected of having caused his acute haemolytic anaemia. Sirornk A R . SklJlrud. 0 M Kiely. JM. and Sundt r M Acta Haemaloroglca 12 346·348 (No 5, 1984)
Transcript of Carbamazepine
Carbamazepine Haemolytic anaemia
The day after a biparietal parasagittal craniotomy for excision 01 a meningioma, a 61-year-old man began laking phenytoin 1QOmg qid for seizure prophylaxis . He had received 4 units 01 whole blood during his operation. Haemoglobin levels were 15.0 gjdl preoperatively, 12.6 9/dl one day after and 10.2 g/dl five days afler surgery . A subgaleal effusion responsive to spinal taps and flap aspiration was fallowed by tever and eosinophilia. Thus, on Ihe eighteenth postoperative day, carbamazepine 100mg tid was given instead of phenytoin and fever resolved quickly. Haemoglobin was 11.3 gfdf. After 20 days' therapy with carbamazepine the patient developed fatigue, dark urine and yellow sclerae and consulted another doctor. Haemoglobin was now 7.6 g/dl, leucocyte count was 5.7 x 109/ L, direct and indirect Coombs tests were negative and reticulocytes were 1.9%. Serum lactic dehydrogenase was 1820 U/l and bilirubin 3.2 mg/dl. Free haemoglobin and protein 2 + were present in urine, A transfusion of 3 units of packed red blood cells was given and carbamazepine discontinued.
Four days later the patient returned to the inilial inslltulion with symptoms already much improved. laboratory findings were: haemoglobin 9.6 g/dl,; leucocyte count 7.8 x 109/L; mean cell volume 85.711 ; platelet count 264 x 109/L; reticulocytes 8.1 % and serum lotal bilirubin concentration 1.2 mgjdl. Serum lactic dehydrogenase was 4 times the normal value and aspartate aminotransferase was slightly elevated. Direct Coombs lest and antibody screening were negative. The patient was discharged. Seven months later haemoglobin was 15.1 g/dl, leucocyte count 6.0 X 109/L and reticulocyles were 1%_ Direcl Coombs test was negative and red cell glucose-6·phosphate dehydrogenase normal.
Laboratory findings and rapid recovery following cessation of carbamazepine do not support a diagnosis of hepatitis for this patient. Negative Coombs tests and antibody screening plus the 5·week delay after surgery before the reaction occurred make a delayed haemolytic transfusion reaction unlikely A rare but potentially dangerous adverse reaction to carbamazepine is suspected of having caused his acute haemolytic anaemia. Sirornk A R . SklJlrud. 0 M Kiely. JM. and Sundt r M Acta Haemaloroglca 12 346·348 (No 5, 1984)
