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Posted On : 20 Jul 2015

a 12 yrs old boy having GTCS for last 7 yrs.he is on tab valparin for last 7 yrs.now he is having typhod fever.his widal report is positive.his platelet count has come down to 45000.SHOULD WE STOP TAB VALPARIN.WHEN WE SHOULD GO FOR PLATELET TRANSFUSION_?

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Answer 1

Thrombocytopenia is a known side-effect of valparin therapy. It is dose-related. In some cases, platelet counts may normalize with continued treatment. Dose may be reduced or one may stop the drug if the patient develops signs of haemorrhage, bruising etc. Otherwise, monitoring of platelet counts is sufficient.

In this case, you do not need to stop valproate, especially if the patient’s seizures have been under control for the last few years. Also, never discontinue anticonvulsants abruptly, as they may increase seizure frequency. If required, then they should be tapered gradually. Presently, you only need to monitor platelet counts regularly every 3-4 days.

As far as platelet transfusion is concerned, there are certain guidelines. Platelet transfusions are indicated if:
1.platelets Less than 50000 and bleeding
2.platelets Less than 50000 and an invasive procedure
3.platelets Less than 20000 and marrow failure with haemorrhagic risk factors
4.platelets Less than 10000 and marrow failure with or without haemorrhagic risk factors
5.platelets at any count but with platelet dysfunction plus bleeding or an invasive procedure

Therefore, your patient does not require platelet transfusion at present. But if he develops any of the above indications, then he may need.

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