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Hemolytic Anemia: Sneaky Cause, Leaky Valve.
Cureus. 2020 May 31; 12(5):e8370.C

Abstract

Intravascular hemolysis is a known complication of prosthetic heart valves. Severe hemolysis is rare (<1%) with the use of newer generation prosthetic valves. This usually occurs due to paravalvular leaks (PVLs). We present a case of hyperbilirubinemia and hemolytic anemia occurring as a result of a PVL of a prosthetic mechanical mitral valve. The patient was a 49-year-old female with a past medical history of rheumatic heart disease status following two mitral valve replacements each with a mechanical prosthesis; she presented with a complaint of worsening fatigue, epigastric pain, nausea, and vomiting. On examination, she had scleral icterus. Heart auscultation revealed a crisp mechanical S1 click and a soft 2/6 systolic murmur in the left lower sternal border. Her abdomen was soft with mild epigastric and right upper quadrant tenderness, and no Murphy's sign. Her labs revealed a white blood cell count of 7.0 x 103/microliter, hemoglobin 10.5 g/dL, hematocrit 29.7%, total bilirubin 6.9 mg/dL, direct bilirubin 0.8 mg/dL, alkaline phosphatase (ALP) 62 U/L, aspartate aminotransferase (AST) 79 U/L, and alanine aminotransferase (ALT) 56 U/L. An ultrasound of the abdomen revealed cholelithiasis without pericholecystic fluid collection and no ultrasonographic Murphy's sign. Magnetic resonance cholangiopancreatography ruled out acute cholecystitis or intra- or extra-hepatic biliary ductal dilatation. A transesophageal echocardiogram showed a well-seated mitral valve prosthesis with a significant PVL and likely moderate mitral regurgitation. The patient was evaluated for possible hemolysis. Lactate dehydrogenase was 1155 U/L, haptoglobin was <30 mg/dL, and reticulocyte count was 5.2%. She underwent a mitral valve re-replacement with a mechanical prosthesis. An echocardiogram after the surgery showed the mechanical prosthesis mitral valve with no residual PVL.

Authors+Show Affiliations

Internal Medicine, Crozer-Chester Medical Center, Upland, USA.Internal Medicine, Crozer-Chester Medical Center, Upland, USA.Cardiothoracic Surgery, Crozer-Chester Medical Center, Upland, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32626614

Citation

Rai, Maitreyee, et al. "Hemolytic Anemia: Sneaky Cause, Leaky Valve." Cureus, vol. 12, no. 5, 2020, pp. e8370.
Rai M, Ali MU, Geller C. Hemolytic Anemia: Sneaky Cause, Leaky Valve. Cureus. 2020;12(5):e8370.
Rai, M., Ali, M. U., & Geller, C. (2020). Hemolytic Anemia: Sneaky Cause, Leaky Valve. Cureus, 12(5), e8370. https://doi.org/10.7759/cureus.8370
Rai M, Ali MU, Geller C. Hemolytic Anemia: Sneaky Cause, Leaky Valve. Cureus. 2020 May 31;12(5):e8370. PubMed PMID: 32626614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemolytic Anemia: Sneaky Cause, Leaky Valve. AU - Rai,Maitreyee, AU - Ali,Muhammad Usman, AU - Geller,Charles, Y1 - 2020/05/31/ PY - 2020/7/7/entrez PY - 2020/7/7/pubmed PY - 2020/7/7/medline KW - anemia and hyperbilirubinemia KW - hemolytic anemia KW - mechanical mitral valve complications KW - paravalvular leaks SP - e8370 EP - e8370 JF - Cureus JO - Cureus VL - 12 IS - 5 N2 - Intravascular hemolysis is a known complication of prosthetic heart valves. Severe hemolysis is rare (<1%) with the use of newer generation prosthetic valves. This usually occurs due to paravalvular leaks (PVLs). We present a case of hyperbilirubinemia and hemolytic anemia occurring as a result of a PVL of a prosthetic mechanical mitral valve. The patient was a 49-year-old female with a past medical history of rheumatic heart disease status following two mitral valve replacements each with a mechanical prosthesis; she presented with a complaint of worsening fatigue, epigastric pain, nausea, and vomiting. On examination, she had scleral icterus. Heart auscultation revealed a crisp mechanical S1 click and a soft 2/6 systolic murmur in the left lower sternal border. Her abdomen was soft with mild epigastric and right upper quadrant tenderness, and no Murphy's sign. Her labs revealed a white blood cell count of 7.0 x 103/microliter, hemoglobin 10.5 g/dL, hematocrit 29.7%, total bilirubin 6.9 mg/dL, direct bilirubin 0.8 mg/dL, alkaline phosphatase (ALP) 62 U/L, aspartate aminotransferase (AST) 79 U/L, and alanine aminotransferase (ALT) 56 U/L. An ultrasound of the abdomen revealed cholelithiasis without pericholecystic fluid collection and no ultrasonographic Murphy's sign. Magnetic resonance cholangiopancreatography ruled out acute cholecystitis or intra- or extra-hepatic biliary ductal dilatation. A transesophageal echocardiogram showed a well-seated mitral valve prosthesis with a significant PVL and likely moderate mitral regurgitation. The patient was evaluated for possible hemolysis. Lactate dehydrogenase was 1155 U/L, haptoglobin was <30 mg/dL, and reticulocyte count was 5.2%. She underwent a mitral valve re-replacement with a mechanical prosthesis. An echocardiogram after the surgery showed the mechanical prosthesis mitral valve with no residual PVL. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/32626614/Hemolytic_Anemia:_Sneaky_Cause,_Leaky_Valve L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32626614/ DB - PRIME DP - Unbound Medicine ER -
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