Publish in this journal
Journal Information
Vol. 55. Issue 9.
Pages 987 (September 2002)
Full text access
Hemolytic Anemia Secondary to Paravalvular Regurgitation
Anemia hemolítica secundaria a regurgitación periprotésica
Vanessa Roldána, Francisco Marínb, Vicente Climentb
a Unidad de Hematología. Hospital de San Vicente. Alicante. 
b Servicio de Cardiología. Hospital General Universitario. Alicante. España.
This item has received
(Daily data update)
Article information
Full Text
Download PDF
Figures (3)
Show moreShow less
Full Text

A 73-year-old woman was admitted for severe anemia 2 months after mitral and aortic cardiac valve replacement with Saint Jude mechanical prostheses. The differential blood count showed macrocytic anemia (hemoglobin 7.1 g/dL; MCV 111 fl; corrected reticulocyte count, 3.5%). The blood smear revealed marked anisopoikilocytosis, intense polychromasia, and abundant schistocytes (Figure 1, arrows). Total bilirubin was 1.76 mg/dL (indirect bilirubin, 1.36 mg/dL). LDH was markedly increased (5259 U/L) and haptoglobin reduced (6.0 mg/dL; normal, 100-300 mg/dL), which was compatible with intravascular hemolysis. The serum was brownish colored secondary to hemoglobinemia and the presence of methemalbuminemia, a product of erythrocyte fragmentation, which originates a characteristic color (Figure 2 A). The urine had a similar color (Figure 2 B). Transesophageal echocardiography revealed severe mitral periprosthetic regurgitation (Figure 3), as well as moderate aortic periprosthetic regurgitation.

Fig. 1.

Fig. 2.

Fig. 3.

Conservative treatment was attempted, but the patient required a large number of transfusions (more than 2 units of packed red blood cells per week), so surgical repair was decided on. Mitral and aortic cardiac valve replacement was performed with Carpentier-Edwards biological prostheses, with good results.

The most frequent causes of hemolytic anemia in patients undergoing valve replacement are mechanical trauma by disks to red blood cells and periprosthetic regurgitation. The treatment is generally medical, but surgical repair is required for periprosthetic regurgitation.

Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.