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Introduction

  • RBCs are damaged in systemic circulation due to force delivered in large caliber vessels or the heart itself
  • Associated conditions
    • mechanical heart valves 
    • calcified or stenotic heart valves
      • most commonly aortic valve
Presentation
  • Symptoms
    • anemia 
      • fatigue
      • jaundice
      • pallor
      • shortness of breath
Evaluation
  • Labs 
    • decreased Hgb
    • increased reticulocyte %
    • increased unconjugated bilirubin
    • increased LDH
    • decreased haptoglobin
  • Blood smear: 
    • schistocytes (helmet cells) 
      • due to shearing mechanical destruction
    • burr cells (echinocytes)
    • Normal platelet count
Treatment
  • Pharmacologic
    • chronic blood transfusions
      • indicated for anemic episodes
  • Operative
    • repair of defective valve OR replacement of previous prosthetic valve
      • indicated in severe cases
 

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