Hemolytic anemia after percutaneous coronary intervention (PCI): A case report

In clinical practice, intravascular hemolysis is not common after interventional cardiovascular procedures. Although diagnostic and treatment techniques have developed, with the increasing importance placed on people's own health and the popularity of cardiovascular intervention, there have been occasional reports of hemolysis after different cardiovascular interventions, mainly including cardiac pacemaker implantation, atrial-fibrillation radiofrequency ablation, transcatheter aortic-valve implantation (TAVI), transcatheter mitral valve replacement (TMVR) and percutaneous repair of Gerbode defect and percutaneous coronary intervention (PCI) with Impella. However, so far, there have been no relevant reports on postoperative hemolysis after percutaneous coronary intervention (PCI).

This article reports a very rare case of a 42-year-old male who developed hemolysis after PCI. The patient had dark brown urine for two days. Blood test showed significant decreases in red blood cell (RBC) and hemoglobin (Hb). After blood transfusion of 2 units, dexamethasone treatment and repeat PCI, he gradually recovered with no symptoms of further episodes of hemolysis.

Due to the use of antiplatelet and anticoagulation drugs in PCI patients, gastrointestinal bleeding (GIB) is often believed to be the main cause of postoperative bleeding events. Identifying the etiology of anemia in patients after PCI is crucial for targeted treatment in the later stage. Based on the symptoms of dark brown urine and the levels of RBC, HB, reticulocyte and unconjugated bilirubin (UCB), we finally diagnosed the patient with hemolytic anemia (HA), rather than the traditional consciousness of GIB. This is an uncommon case of hemolysis after PCI. Although the association between PCI and HA is very rare, PCI is now a commonly used treatment for patients with acute coronary syndromes (ACS). Therefore, clinicians should recognize that in addition to GBI, HA may also occur after PCI. Early recognition of the cause of anemia and early treatment is one of the key steps to ensure the later life and health of PCI patients.