Intravascular haemolysis and thrombocytopenia in left ventricular outflow obstruction.

Jacobson, Robert J.; Rath, Charles E.; Perloff, Joseph K.

doi:10.1136/hrt.35.8.849

Cited by 36 publications

(27 citation statements)

References 12 publications

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“…When a pressure gradient of more than 50 mmHg is present across a valve, shearing stress can exceed 4,000 dynes/cm 2 . Theoretically, a shearing stress of more than 3,000 dynes/cm 2 can cause fragmentation of red blood cells (2)(3)(4). The present patient's pressure gradient was more than 150 mmHg, which was potentially high enough to cause hemolysis.…”

Section: Discussionmentioning

confidence: 62%

“…Intravascular hemolysis may occur with hemolysis-prone erythrocytes or, if shear forces are great enough, with normal erythrocytes (1). Jacobson et al (2) reported that intravascular hemolysis develops when pressure gradients of 50 mmHg or more occurred in aortic stenosis. When a pressure gradient of more than 50 mmHg is present across a valve, shearing stress can exceed 4,000 dynes/cm 2 .…”

Section: Discussionmentioning

confidence: 99%

“…The most common cardiovascular cause of intravascular hemolysis is paravalvular insufficiency around a prosthetic valve (1). However, there are few reports of intravascular hemolysis related to insufficiency or stenosis of the native valve (2).…”

Section: Introductionmentioning

confidence: 99%

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Intravascular Hemolysis in Aortic Stenosis

et al. 2004

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A 67-year-old woman with rheumatic aortic stenosis for 20 years was admitted to our hospital. Although she had no overt symptoms, she had severe aortic valve stenosis with a transvalvular pressure gradient of more than 150 mmHg. She had also been suffering from anemia and mild chronic renal failure. A peripheral blood smear showed numerous fragmented erythrocytes. Hemoglobin was 8.4 g/dl, lactate dehydrogenase was 316 IU/l, haptoglobin was less than 7.3 mg/dl, and hemosiderinuria was evident. We diagnosed intravascular hemolysis related to aortic stenosis. After we performed an aortic valve replacement, fragmentation on the peripheral blood smear dramatically disappeared.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Intravascular Hemolysis in Aortic Stenosis

et al. 2004

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“…4) Intracardiac high velocity jets through stenosed or incompetent orifices can cause intravascular hemolysis, but few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. 11,12) Accordingly, we evaluated the presence of intravascular hemolysis by measuring erythrocyte creatine and examined the relation between erythrocyte creatine and hemodynamic parameters in patients with aortic stenosis.…”

Section: Ntravascular Hemolysis Has Been Identified In Patients Withmentioning

confidence: 99%

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

et al. 2016

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SummaryChronic intravascular hemolysis has been identified in patients with cardiac valve prostheses, but only a few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. To detect intravascular hemolysis in patients with aortic stenosis, erythrocyte creatine was evaluated with hemodynamic indices obtained by echocardiography.Erythrocyte creatine, a marker of erythrocyte age, was assayed in 30 patients with aortic stenosis and 10 aged matched healthy volunteers. Peak flow velocity of the aortic valve was determined by continuous-wave Doppler echocardiography. Twenty of 30 patients with aortic stenosis had high erythrocyte creatine levels (> 1.8 µmol/g Hb) and erythrocyte creatine was significantly higher as compared with control subjects (1.98 ± 0.49 versus 1.52 ± 0.19 µmol/g Hb, P = 0.007). Peak transvalvular pressure gradient ranged from 46 to 142 mmHg and peak flow velocity ranged from 3.40 to 5.95 m/second. Patients with aortic stenosis had a significantly lower erythrocyte count (387 ± 40 versus 436 ± 42 × 10 4 µL, P = 0.002) and hemoglobin (119 ± 11 versus 135 ± 11 g/L, P < 0.001) as compared with control subjects. Erythrocyte creatine had a fair correlation with peak flow velocity (r = 0.55, P = 0.002).In conclusion, intravascular hemolysis due to destruction of erythrocytes was detected in patients with moderate to severe aortic stenosis and the severity of intravascular hemolysis was related to valvular flow velocity of the aortic valve. (Int Heart J 2016; 57: 430-433)

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“…The enhanced shear stress associated with stenosis of the native aortic valve can theoretically induce intravascular hemolysis. [31][32][33] Aortic stenosis is sometimes associated with loss of high molecular von Willebrand multimers and with a greater tendency to bleed. 34,35 Although these issues are of clinical significance only in cases of severe anemia requiring transfusion, mild anemia in our subjects may exist in part because of these mechanisms.…”

Section: Prognostic Factors For Progression Of Early-stage Cavdmentioning

confidence: 99%

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Yamamoto

Yoshida

et al. 2010

Hypertens Res

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Calcific aortic valve disease (CAVD) is the most common etiology of acquired valvular heart disease, and hypertension is a principal underlying disease. The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis is a retrospective observational study to clarify the prognostic factors for progression of CAVD in Japanese. Data from 556 subjects who met the following criteria were analyzed: (1) X50 years old; (2) calcification in any aortic valve leaflet or peak aortic jet velocity X2 m s À1 on an echocardiographic study performed between July 2004 and June 2007; and (3) availability of earlier echocardiographic data from within the previous 2-5 years to assess the progression of CAVD. The subjects were divided into two groups according to CAVD severity on the preceding echocardiographic examination. In early-stage subjects with calcification in one or zero leaflets who were without aortic stenosis on the preceding echocardiographic study (n¼157), the prognostic factors for progression were the following: (1) no use of angiotensin receptor blockers (ARB) and (2) use of warfarin. In late-stage subjects with calcification in two or three leaflets and/or aortic stenosis on the preceding echocardiographic study (n¼399), progression was observed in females and in subjects with low hemoglobin and a concentric left ventricle. There was no relation between medications and changes in CAVD. Prognostic factors for the progression of CAVD were different between the early and late stages. Initiation of ARB treatment during the early stage may be effective, and we should be vigilant about progression of CAVD in patients treated with warfarin.

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Intravascular haemolysis and thrombocytopenia in left ventricular outflow obstruction.

Cited by 36 publications

References 12 publications

Intravascular Hemolysis in Aortic Stenosis

Intravascular Hemolysis in Aortic Stenosis

Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

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