Hemolytic anemia can occur with prosthetic heart valves but often is mild and does not require transfusion. More severe hemolysis can occur in certain situations.
Risk factors for hemolytic anemia:
(1) malfunctioning mechanical valve
(2) paravalvular leak
Workup would include:
(1) hemoglobin concentration
(2) serum haptoglobin
(3) serum LDH
(4) serum iron
(5) direct antiglobulin tests
(6) peripheral blood smear review
(7) reticulocyte count
Common Terminology Criteria (CTC) for anemia can be used to grade the hemolytic anemia.
Clinical Status
Laboratory Findings
Grade
no or mild symptoms
hemoglobin >= 10 g/dL
1
moderate symptoms with some limitations in activities
hemoglobin 8-10 g/dL
2
severe symptoms with significant limitation of activities; requires transfusion
hemoglobin < 8 g/dL
3
life-threatening with need for urgent intervention
NA
4
death
NA
5
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