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Severe paravalvular mechanical hemolysis with a normal blood smear
R D Hockett1, L Krewson, A Weiss
1Department of Pathology Medicine, Washington University School of Medicine, St. Louis, Missouri 63110.
American Journal of Clinical Pathology
|October 1, 1989
Summary
Severe hemolysis due to prosthetic mitral valve leakage resolved after surgical repair. This case highlights a unique absence of red blood cell fragments despite significant hemolysis, with successful treatment outcomes.
Area of Science:
- Cardiology
- Hematology
- Medical Device Engineering
Background:
- Paravalvular leakage (PVL) around prosthetic heart valves can lead to serious complications.
- Hemolysis, the destruction of red blood cells, is a known complication of PVL.
Observation:
- A 74-year-old female presented with severe hemolysis attributed to PVL around a prosthetic mitral valve.
- A unique observation was the absence of characteristic red blood cell fragments (schistocytes) in peripheral blood smears.
Findings:
- Surgical repair of the primary suture line successfully addressed the paravalvular leakage.
- Following repair, the patient no longer required red blood cell transfusions, averaging 3-4 units weekly.
- All clinical and laboratory evidence of hemolysis resolved, with hematologic values normalizing within six months.
Implications:
- This case underscores the importance of surgical intervention for PVL causing hemolysis.
- The absence of schistocytes in this severe hemolysis case warrants further investigation into diagnostic markers.
- Successful valve repair demonstrates a viable treatment strategy for prosthesis-related hemolysis.