Valproate‐induced pure red cell aplasia and megakaryocyte dysplasia
Bibliographic record
Abstract
A 13-year-old girl presented with a 4-d history of pallor, headache and fever. She had been taking valproic acid 375 mg twice daily for the previous 3 months for a seizure disorder. Prior to that she had been taking other anticonvulsants but had never taken valproic acid. She had an underlying mild developmental delay, a learning disability and epilepsy. No specific diagnosis to account for these has ever been determined. At presentation she exhibited severe pallor but was not jaundiced. She did not have any lymphadenopathy or hepatosplenomegaly. A complete blood count showed a haemoglobin of 29 g/l, a white blood cell count of 4·3 × 109/l and a platelet count of 425 × 109/l. The absolute reticulocyte count was 0. Her serum electrolytes, liver function tests and renal function tests were all within normal limits. Her serum valproic acid level was 467 μmol/l (therapeutic range: 350–690 μmol/l). A bone marrow aspirate showed normal myeloid precursors and marked erythroid hypoplasia (left). Megakaryocytes displayed abnormal nuclear features (right). The peripheral blood and the bone marrow aspirate samples were negative for parvovirus B19, Epstein-Barr virus and cytomegalovirus DNA by polymerase chain reaction. A diagnosis of valproic acid-induced pure red cell aplasia (PRCA) with megakaryocytic dysplasia was made. She was treated with packed red blood cell transfusions and the valproic acid was discontinued; she was commenced on an alternate antiepileptic medication. Reticulocyte count recovery was noted (absolute reticulocyte count of 93 × 109/l) 3 weeks later. Valproic acid-induced PRCA has been described in a few case reports, and has resolved upon its discontinuation in most cases. It is also known to affect the myeloid and megakaryocytic lineages; haematologists should be aware of this rare adverse effect of valproic acid.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".