Intravascular Hemolysis in a Patient with Valvular Heart Disease

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Abstract
The in vivo role of mechanical factors as a cause of increased destruction of red blood cells has received greater attention in recent times. This phenomenon has been observed in patients with small blood vessel diseases, hemolytic disorders, and recently most frequently following insertion of prosthetic materials, as cardiac valves. In the present report the clinical course and special studies of red cells in a patient with rheumatic mitral and aortic valvular heart disease have been described. A fall in hemoglobin, rise of reticulocytes and the presence of hemosiderin in the urine suggested intravascular hemolysis. The red cell survival using radio-chromated red cells was normal during a time when the patient was maintained at relative rest. Definite shortening of red cell survival with a fall in hemoglobin occurred when the patient was regularly exercised. These studies have documented completely for the first time intravascular hemolysis occurring on the basis of damaged valves per se. Hemolysis is presumably accentuated by increased hemodynamic factors. The phenomenon described in this patient must be infrequent, since of 20 other patients studied in this series no other similar example was detected.