Updated: 11/10/2017

Macroangiopathic Anemia

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Topic
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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Questions (2)
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(M1.HE.13.124) A 62-year-old woman is evaluated for fatigue 6 months after placement of a mechanical valve due to aortic stenosis. She does not drink alcohol or smoke cigarettes. A complete blood count reports hemoglobin of 9.5 g/L and a reticulocyte percentage of 5.8%. Platelet and leukocyte counts are within their normal ranges. The patient’s physician suspects traumatic hemolysis from the patient’s mechanical valve as the cause of her anemia. Which of the following peripheral blood smear findings would most support this diagnosis? Tested Concept

QID: 101434
1

Bite cells and Heinz bodies

10%

(27/258)

2

Sickle cells and target cells

2%

(6/258)

3

RBC fragments and schistocytes

83%

(215/258)

4

Round macrocytes and target cells

1%

(3/258)

5

Macrocytes and hypersegmented neutrophils

0%

(1/258)

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