Hemolitic<sp?>Anemia and INR

[Wayne G]

I read an article that said patients with anemia have a difficult time keeping their INR consistant, has anyone ran into this? I have had a hemogolbin level of 7 to 9 since I had my first ATS aortic valve back in May of this year. Since May my INR has been all over the place. Normally I take 5mg a day (35mg per week) but have been as high as 40mg and as low as 30mg to try and keep my INR between 2.5 and 3.5. Has my second valve in September of this year ( first one was leaking at the surtures) and still have a problem with anemia and keeping my level with in range.I have ran as 4.9 and dropped 2.5 mg per week only to have my level drop to 2.3 in 5 days. I try to keep my Vit K consistant at one serving per day and I don't drink alcohol or take any herbals. Current hemogolbin is 8.9 and have been diagnosed as having hemolsis<sp> caused by by my mech. valve ( 2 of them I guess as I have been anemic since the first valve in May). Any idea's?

 

[RandyL]

Wayne,
I'm not sure but are you the fella that had his incesion open up and also had to go back in to replace your Mech valve that wasn't working properly?

Sorry your having problems. I read somewhere that a 10 was normal for a mechanical valve, recently I was tested at a 11 myself and I guess 13-15 is normal. My fingernails don't have much color in them and lately my INR has been acting up when before it was steady as a rock. My Mech valve that they put in a year ago is leaking and there is also some concern that the valve is chewing up blood cells.

 

[Nancy]

Wayne-

From your past posts, I read that you are going to a hematologist for this problem. I hope you still are.

You really need to find out if there is any underlying medical condition that is causing your anemia besides the mentioned hemolysis.

You need to discuss with your doctor, the possibility of renal, liver and spleen problems, and have someone monitor your GI tract with occult blood testing.

And you should be having BMP testing regularly.

How is your hematologist treating your anemia?

As I mentioned before, Joe had this problem for a LONG time. His was a combo of many things.

If they are just treating it with transfusions, then it is entirely possible to have your bloodwork show up just fine right after, and later start to drop again slowly. This happened to Joe, over and over. The transfusions made his INR swing also, since it introduced non-anticoagulated blood into his bloodstream.

AND if there were transfusions, his doctors also had to take into account the extra blood volume and possibly give him diuretics so as not to overload his heart.

This is a problem you should not let anyone dally around with. It can affect your quality of life and certainly how tired you feel, and how stressed your heart is. Blood carries needed oxygen throughout the body.

If you do not like the care you are getting and feel that things are not being pursued carefully, then find another doctor to help you out.

You've got to be under doctors' care for this.

 

[Guest]

Ideally your hematologist should not also be an oncologist. The oncology part is overwhelming many who try to do both specialties. As a result the hematology part gets neglected.

It hay be that the mechanical valve is damaging the red blood cells. If this happens, you will not get accurate readings on the type of testers that require blood from a venous draw. You might need to use fingersticks only.

 

[briansmom]

Al,
Can you expound on the venous draw vs the fingerstick. My son is also anemic and we have not been able to get his INR above 1.5. His draws have been venous every time.
Deanne

 

[Guest]

It has to be hemolytic anemia. This means that the red blood cells have broken and the hemoglobin has gotten out.

The blood draw process goes like this. You get the blood from a vein and put it in a blue-top tube (blue means anticoagulant in it). The tube goes into a centrifuge and spins the heavier red blood cells to the botton. Then you take a long thing like a medicine dropper and draw the plasma off the top of the red blood cells. This plasma is what is tested for coagulation factors.

If the blood is hemolyzed, the plasma on top will be pink to red. The color evidently interferes with the test. (There must be a lab person on here who knows the exact reason.)

When you do finger-stick testing you are using whole blood so hemolysis makes no difference.

However, the fingerstick test depends on the ability of the blood to run up a tube. If you have iron-deficiency then the blood runs up the tube too fast. So these people must have venous draws because that method is not dependent on the blood running up a tube.

 

[bvdr]

It has to be hemolytic anemia. This means that the red blood cells have broken and the hemoglobin has gotten out.

The blood draw process goes like this. You get the blood from a vein and put it in a blue-top tube (blue means anticoagulant in it). The tube goes into a centrifuge and spins the heavier red blood cells to the botton. Then you take a long thing like a medicine dropper and draw the plasma off the top of the red blood cells. This plasma is what is tested for coagulation factors.

If the blood is hemolyzed, the plasma on top will be pink to red. The color evidently interferes with the test. (There must be a lab person on here who knows the exact reason.)

When you do finger-stick testing you are using whole blood so hemolysis makes no difference.

However, the fingerstick test depends on the ability of the blood to run up a tube. If you have iron-deficiency then the blood runs up the tube too fast. So these people must have venous draws because that method is not dependent on the blood running up a tube.

Al, is the reason that blood with a hemoglobin over 17 can't be finger tested also because it can't run up a tube? Just wondering. You mentioned high hemoglobins at one time and since mine usually is about 16 and sometimes a little above I tucked that info back into the recesses of my mind. Are there some other situations where fingersticks are the only accurate way of testing? Or situations where only venous draws give any sense of accuracy?

 

[Guest]

I don't know about the hemoglobin level it is the hematocrit over 52% that stops CoaguCheks.

 

[LUVMyBirman]

Yes indeed. Had or have this issue. I did see a good hemotoligist/oncoligist for about a year to get things in check. He prescibed an RX iron supplement (Chromagen). Have been taking it once a day for the past 7 years. Once I started the iron....my INRs became more consistant. It keeps my levels at the lower end of normal.

 

[bvdr]

I don't know about the hemoglobin level it is the hematocrit over 52% that stops CoaguCheks.

Thanks, Al. My last H&H was 16.2/48.2. I must have just figured that if my Hemoglobin approached 17 then my protime might not be accurate. Do you think that it would apply to the Protime unit as well? I would imagine that the machine would just display error if the hematocrit was too high? Thanks again.

 

[Guest]

The ProTime will work with hematocrits up to 60%.