Medical expert of the article

Hematologist, oncohematologist

New publications

Hemolytic anemias associated with mechanical damage to the red blood cell membrane

Alexey Kryvenko, medical expert
Last reviewed: 04.07.2025

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.

If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.

What tests are needed?
Who to contact?

Hemolytic anemias associated with mechanical damage to the erythrocyte membrane occur in patients with aortic valve prostheses due to intravascular destruction of erythrocytes. Hemolysis is caused by the design of the prosthesis (mechanical valves) or its dysfunction (perivalvular regurgitation). Bioprostheses and artificial valves in the mitral position rarely lead to significant hemolysis. Mechanical hemolysis is also observed in patients with synthetic arterial shunts. When examining a peripheral blood smear, schistocytes and other erythrocyte fragments are found (these signs of mechanical hemolysis are present, although to a lesser extent, with normally functioning prostheses). Free plasma hemoglobin is elevated, haptoglobin is reduced or not detected, hemosiderin is usually detected in the urine. Treatment is aimed at eliminating the dysfunction of the prosthesis.

Causes of hemolytic anemia associated with mechanical damage to the red blood cell membrane

Kidney diseases	Hemolytic uremic syndrome Renal vein thrombosis Rejection of transplanted kidney Radiation nephritis Chronic renal failure
Cardiovascular diseases	Malignant hypertension Coarctation of the aorta Damage to the valve apparatus Subacute bacterial endocarditis of the aortic Valves Bioprostheses
Liver diseases	Severe hepatocyte damage
Infections	Disseminated herpes infection Meningococcal sepsis Malaria
Other	Thrombotic thrombocytopenic purpura DIC syndrome of any etiology Severe burns Giant hemangioma Metastasis of tumors Medicines (mitomycin C, cyclosporine)

Microangiopathic hemolytic anemia is another syndrome of mechanical intravascular hemolysis, apparently caused by fibrin deposition in small vessels. The disease occurs in disseminated intravascular coagulation syndrome, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, severe arterial hypertension, vasculitis, eclampsia, and some disseminated tumors. Fragmented erythrocytes (helmet cells, schistocytes) and thrombocytopenia are detected in peripheral blood smears. Treatment is aimed at stopping the primary pathological process.

trusted-source [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]