Prosthetic valve hemolysis aggravated by gastrointestinal bleeding

A case is presented of a patient with 2 prosthetic valves and a mild chronic hemolytic anemia, in whom the hemolysis was suddenly aggravated by the occurrence of an acute gastrointestinal hemorrhage. This increased hemolysis was readily reversed by transfusion. It is postulated that the pathogenetic mechanism of this process was the increased direct crushing trauma and turbulence, both of which resulted from the tachycardia initiated by the gastrointestinal hemorrhage. The importance of avoiding or correcting tachycardia in patients with prosthetic valves is emphasized.