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Hematologist, oncohematologist

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Hemolytic anemia associated with mechanical damage to the erythrocyte membrane

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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Hemolytic anemia associated with mechanical damage to the erythrocyte membrane occurs in patients with aortic valve prostheses due to intravascular erythrocyte destruction. Hemolysis is caused by the device of the prosthesis (mechanical valves) or its dysfunction (near-valvular regurgitation). Bioprosthesis and artificial valves in the mitral position rarely lead to significant hemolysis. Mechanical hemolysis is also observed in patients with synthetic arterial shunts. In the study of the peripheral blood smear, there are schizocytes and other fragments of erythrocytes (these signs of mechanical hemolysis are present, although to a lesser extent, with normally functioning prostheses). Free plasma hemoglobin is elevated, haptoglobin is lowered or not detected, in the urine is usually determined hemosiderin. Treatment is aimed at eliminating dysfunction of the prosthesis.

Causes of hemolytic anemia associated with mechanical damage to the erythrocyte coat

Kidney Diseases	Hemolytic-uremic syndrome Thrombosis of renal veins Rejection of the transplanted kidney Radiation Jade Chronic Renal Failure
Diseases of the cardiovascular system	Malignant hypertension Coarctation of the aorta Defects of the valve apparatus Subacute bacterial endocarditis of the aortic Valve Bioprosthesis
Diseases of the liver	Severe hepatocyte damage
Infections	Disseminated herpetic infection Meningococcal sepsis Malaria
Other	Thrombotic thrombocytopenic purpura DIC-syndrome of any etiology Severe burns Giant Hemangioma Metastasis of tumors Medications (mitomycin C, cyclosporin)

Microangiopathic hemolytic anemia is another syndrome of mechanical intravascular hemolysis, apparently due to the deposition of fibrin in small vessels. The disease occurs with the syndrome of disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, severe arterial hypertension, vasculitis, eclampsia, and some disseminated tumors. In the smears of peripheral blood, fragmented erythrocytes (helmet cells, schizocytes), as well as thrombocytopenia, are revealed. Treatment is aimed at arresting the primary pathological process.

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