🔬 Clinical case: mechanical hemolytic anemia in paravalvular leak
Patient: A 71-year-old man with rheumatic heart disease who underwent mitral and aortic valve replacement. Complaints — increasing shortness of breath and anemia (Hb decreased from 12–13 to 6.8 g/dL).
Key findings: ✔️ Macrocytic anemia (MCV 106.4 fL) ✔️ Signs of hemolysis: ⬆️ LDH (2436 U/L), ⬆️ bilirubin, polychromasia in blood smear ✔️ Microangiopathic changes — schistocytes (fragmented erythrocytes, see photo). ✔️ DIC syndrome, PNH (negative CD55/CD59 test) and B12 deficiency were excluded.
Diagnosis: Hemolysis due to paravalvular leak (confirmed by transesophageal echocardiography).
Treatment:
- Valve replacement/correction
- Iron and folic acid supplements
- Monitoring for complications (thrombosis, CKD).
📌 Important: Schistocytes + hemolysis in a patient with a prosthetic valve → always rule out paravalvular leak!
🔎 Source: Leung A.Y.H. Haematology and the Asian Patient (2024).
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