Macroangiopathic Anemia

Introduction

• RBCs are damaged in systemic circulation due to force delivered in large caliber vessels or the heart itself
• Associated conditions
  • mechanical heart valves 
  • calcified or stenotic heart valves
• most commonly aortic valve

Presentation

• Symptoms
  • anemia 
    • fatigue
    • jaundice
    • pallor
• shortness of breath

Evaluation

• Labs 
  • decreased Hgb
  • increased reticulocyte %
  • increased unconjugated bilirubin
  • increased LDH
  • decreased haptoglobin
• Blood smear: 
  • schistocytes (helmet cells) 
    • due to shearing mechanical destruction
  • burr cells (echinocytes)
• Normal platelet count

Treatment

• Pharmacologic
  • chronic blood transfusions
    • indicated for anemic episodes
• Operative
  • repair of defective valve OR replacement of previous prosthetic valve
    • indicated in severe cases