Introduction Schistocyte in Macroangiopathic Hemolytic Anemia 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