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Valproate Pre-Op Bloods — FRCA Final MCQ

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ModeratePaediatric AnaesthesiaValproate Pre-Op BloodsFRCA Final

A 12-year-old girl (40 kg) with epilepsy controlled on sodium valproate and levetiracetam requires a dental extraction under GA. Which specific laboratory test should be checked pre-operatively given her sodium valproate use?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Blood glucose

Sodium valproate has specific haematological effects: (1) thrombocytopenia (dose-dependent, affects up to 5-18% of patients), (2) impaired platelet function (independent of count), (3) reduced fibrinogen and Factor XIII levels, (4) hepatotoxicity (elevated transaminases, rarely fulminant hepatic failure). Pre-operative FBC (particularly platelet count), LFTs, and coagulation screen should be checked. If platelets are <80 × 10⁹/L or coagulation is abnormal, neuraxial techniques are contraindicated and surgical bleeding risk increases. Valproate should be continued perioperatively (via NG/IV if needed) to prevent seizures.

Reference: BNF – 2025 – Sodium valproate: monitoring requirements; RCOA – 2023 – Paediatric and epilepsy modules