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Intravascular hemolysis in patients with mitral regurgitation: Evaluation by erythrocyte creatine

Tetsuro Sugiura1, Toshika Okumiya2, Mikio Kamioka1

  • 1Department of Laboratory Medicine, Kochi Medical School, Kochi, Japan.

Journal of Cardiology
|November 28, 2017
PubMed

Insights

Eccentric mitral regurgitation jets cause intravascular hemolysis and anemia by damaging red blood cells. This study measured erythrocyte creatine to assess red blood cell destruction in patients with mitral regurgitation.

Area of Science:

  • Cardiology
  • Hematology
  • Biochemistry

Background:

  • Intravascular hemolysis is known with artificial heart valves.
  • Hemolysis in native mitral regurgitation is not well-understood.
  • This study investigates hemolysis in primary mitral regurgitation.

Purpose of the Study:

  • To determine the impact of regurgitation flow on intravascular hemolysis.
  • To assess red blood cell damage in mitral regurgitation patients.
  • To correlate erythrocyte creatine levels with mitral regurgitation characteristics.

Main Methods:

  • Enzymatic assay of erythrocyte creatine in 29 mitral regurgitation patients and 12 controls.
  • Color Doppler echocardiography to characterize mitral regurgitation.
  • Comparison of erythrocyte creatine, count, and hemoglobin between patient groups and controls.

Main Results:

  • Erythrocyte creatine was significantly higher in patients with eccentric jets (2.64±0.77μmol/g Hb) compared to central jets (1.68±0.13μmol/g Hb) and controls (1.39±0.25μmol/g Hb).
  • Patients with eccentric jets showed lower erythrocyte count (385±58 x10⁴/μL) and hemoglobin (116±19g/l).
  • No significant differences were found in age, GFR, PAP, LA size, or LVEDD between eccentric and central jet groups.

Conclusions:

  • Eccentric mitral regurgitation jets cause intravascular hemolysis and anemia.
  • Red blood cell destruction results from the eccentric jet colliding with the atrial wall.
  • This mechanism explains subclinical anemia in patients with eccentric regurgitation jets.
Abstract

Keywords:
Erythrocyte ageErythrocyte creatineIntravascular hemolysisMitral regurgitation

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