Exercise-induced fragmentation hemolysis: a simple in vivo test to evaluate heart valve hemolysis

Differentiating heart valve-related fragmentation hemolysis from other causes of hemolysis can occasionally be difficult, especially when findings on transthoracic or transesophageal echocardiography are minimal. We report a case in which the cause of hemolysis remained in doubt after thorough hematologic and cardiologic evaluations. The decision to reoperate on the valve was finally made, based on the result of exercise-induced increase in serum hemoglobin. Hemolytic anemia promptly resolved after reoperation. We believe this to be the first reported use of this in vivo test to support the diagnosis of valve-related hemolytic anemia.