Red Blood Cell Survival in Patients with Aortic Valvular Disease and Ball-Valve Prostheses

Abstract

Red blood cell survival was determined in patients with aortic valvular disease, postoperative patients with aortic valvular ball-valve prostheses and postoperative patients with multiple ball-valve prostheses. The red blood cell survival was reduced in the majority of patients in each group when compared with the red blood cell survival from a normal control group. A detailed analysis of the survival curves suggested that in many patients there was more than one population of red blood cells. The first population displayed rapid random destruction. This population was not present in normal persons in the control group. The second population showed the usual decline in radioactivity due to random destruction and loss of the red cell label due to elution. The shortened red blood cell survival in some patients was due to a large percentage of the first population of randomly destroyed red blood cells, in other patients to an accelerated rate of destruction of the usual single population of cells while others had a combination of the two mechanisms. A mechanism of mechanical hemolysis due to increased intracardiac turbulence was suggested as a cause for the shortened survival. When the turbulence was increased by a leak around the aortic or mitral valve prosthesis the red blood cell survival was found to be further decreased. In some cases this reduction in survival was enough to produce hemolytic anemia. The Coombs antiglobulin test was positive in three patients. The suggestion was made that the development of autoantibodies to red blood cells was secondary to increased destruction of red blood cells.

Red Cell Survival after Heterograft Valve Surgery

“…This contrasts with reports of artificial prostheses. Bell et al (1967), in a series of 27 patients with artificial valve prostheses, found evidence of baemolysis in 20, while Brodeur et al (1965) demon-BRITISH MEDICAL JOURNAL 807 strated reduced Ti 5"Cr-labelled red cells in 8 of his 12 patients with Starr-Edwards valve prostheses, the range of values obtained being 9 to 23 days, with a mean of 18 days. Of these 12 patients 7 had normally functioning prostheses and four of them were found to have a reduced Ti for 5'Cr-red cells (18 to 23 days).…”

“…Intravascular haemolysis is a frequent complication of prosthetic valve replacement (Brodeur et al, 1965 ;Rubinson et al, 1966;Bell et al, 1967), and in a significant proportion of cases frank haemolytic anaemia occurs, particularly with incompetent prostheses (Sayed et al, 1961 ;Marsh, 1964;Stevenson and Baker, 1964). Random destruction of red cells due to valve turbulence and shearing forces created by a regurgitant flow of blood form the most likely basis for the haemolysis, and this theory has recently received experimental support (Nevaril et al, 1968).…”

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

“…2,6,7,10) On the other hand, several markers including increased reticulocyte count, schistocyte count, and serum lactate dehydrogenase, or reduced haptoglobin have been applied to estimate the severity of intravascular hemolysis. 1,2,6,7,[18][19][20][21][22][23][24] Among these markers, serum lactate dehydrogenase has been widely used to estimate the severity of intravascular hemolysis in patients with cardiac valve prostheses, because a close relation between serum lactate dehydrogenase and half-life of 51 Crlabeled erythrocytes was demonstrated in patients with cardiac valve prostheses.…”

“…[1][2][3][4][5] Erythrocyte survival with a 51 Cr-labeling method has been utilized to estimate the severity of intravascular hemolysis in patients with prosthetic valves and valvular heart disease, and shortened erythrocyte survival was demonstrated in these patients. 2,6,7) However, the 51 Cr-labeling method requires exclusive equipment for radioactive materials and a prolonged examination period with a series of blood withdrawals from the patient. In contrast, erythrocyte creatine is regarded as a sensitive and quantitative marker of mean age of the erythrocytes, because creatine contents in erythrocytes decrease gradually with advancing cell age and an increase in erythrocyte creatine quantitatively reflects the degree of shortened erythrocyte survival.…”

Hemoglobin Yakima: I. Clinical and Biochemical Studies*

“…Blood volume and erythrocyte survival were measured using 'Cr (5). Hemolysates were prepared by mixing 1 volume of washed, packed erythrocytes, 1 volume of water, and 0.4 volume of toluene for 10 min.…”