关键词: hemolytic anemia intravascular hemolysis prosthetic valve transcatheter mitral valve closure waring blender syndrome

来  源:   DOI:10.7759/cureus.57552   PDF(Pubmed)

Abstract:
A 72-year-old woman with recently diagnosed non-small cell lung cancer, who underwent cardiac bypass and bioprosthetic mitral valve replacement presented to our cancer center with lightheadedness, severe fatigue, and shortness of breath. Initial blood tests showed mild hemolytic anemia. The patient also complained of occasional bright red bleeding per rectum. Esophagogastroduodenoscopy and colonoscopy did not reveal an acute source of bleeding. An initial transesophageal echocardiogram did not show significant valvular or paravalvular abnormalities. Meanwhile, the patient\'s hemolytic anemia worsened. She received eight units of packed red blood cell transfusions. Schematic workup for hemolytic anemia revealed negative Coomb\'s test, positive urine hemosiderin, normal ADAMTS13 activity, and absent splenomegaly. A relook of the patient\'s transesophageal echocardiogram (TEE) showed a small paravalvular leak of the bioprosthetic mitral valve. The patient was referred to a tertiary center, and repair of the perivalvular leak with glue resolved her hemolytic anemia, subsequently improving the lab values, symptoms, and quality of life. This case highlights the schematic workup of hemolytic anemia and also the importance of recognizing the association between hemolytic anemia and valvular abnormalities.
摘要:
一名72岁的女性最近被诊断出非小细胞肺癌,他接受了心脏搭桥和生物人工二尖瓣置换术,头昏眼花地出现在我们的癌症中心,严重疲劳,呼吸急促.最初的血液检查显示轻度溶血性贫血。患者还抱怨每个直肠偶尔有鲜红色出血。食管胃十二指肠镜检查和结肠镜检查未发现急性出血源。最初的经食管超声心动图未显示明显的瓣膜或瓣膜旁异常。同时,患者的溶血性贫血恶化。她接受了八个单位的打包红细胞输血。溶血性贫血的示意性检查显示Coomb试验阴性,尿液含铁血黄素阳性,ADAMTS13活性正常,没有脾肿大。患者的经食道超声心动图(TEE)的回顾显示,生物假体二尖瓣的瓣周漏较小。患者被转诊到三级中心,用胶水修复瓣膜周围的渗漏解决了她的溶血性贫血,随后改善实验室值,症状,和生活质量。该病例强调了溶血性贫血的示意性检查以及认识溶血性贫血与瓣膜异常之间关联的重要性。
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