Blood shearing

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Gail in Ca

Well-known member
Joined
Jun 26, 2001
Messages
1,150
Location
Los Angeles, CA
My mechanical valve is shearing my blood cells. My blood numbers have been going down since 2018. My newest cardiologist thought my valve is probably the culprit. I started seeing a new GP and asked her to check my blood.
Everything was off, so she sent me to a hematologist. More blood tests ordered and one was crazy high. ( lactate dehydrogenase-1660).
He called my cardio and was told I can’t have a 4th surgery so do what he can for my blood. I am now on Trental 3 times a day and he hopes it will trend my numbers up. I am concerned to say the least.
 
Hi

My mechanical valve is shearing my blood cells.
you mean damaging the haemoglobin? So this?

My blood numbers have been going down since 2018. My newest cardiologist thought my valve is probably the culprit. I started seeing a new GP and asked her to check my blood.
Everything was off, so she sent me to a hematologist. More blood tests ordered and one was crazy high. ( lactate dehydrogenase-1660).
does this link match your numbers?
https://www.medchunk.com/tests/ldh-1660
He called my cardio and was told I can’t have a 4th surgery so do what he can for my blood.
pardon me, but why are we suddenly at "another surgery"?

I am now on Trental 3 times a day and he hopes it will trend my numbers up. I am concerned to say the least.

so, is your dietary iron ok? I think there are many other things to consider (which may be already considered but I'm not privy to here) before jumping on the reoperation platform.

I look forward to hearing from you.

Best Wishes
 
Sorry to hear about your troubles Gail. I don't know anything specific to help. Blood cell destruction is a risk. Do you have any symptoms? Beans are often iron rich, baked beans make a nice iron supplement.
 
In 2011 my 6 year old daughter had a mitral valve repair done, and as a result of the repair, developed hemolytic anemia. The repair actually caused the shearing of her red blood cells which led to the anemia. You mentioned your lactate hydrogenase was 1660; my daughter's got as high as 2410. If you'd like to contact me, I can share with you the rather lengthy story of how the cardiologist and hematologist managed this condition, which was not resolved until my daughter eventually had a mitral valve replacement in 2014.

I am assuming your reticulocyte count is also sky high, and your hemoglobin is alarmingly low. Let me know if you'd like to talk.
 
Yes, I have hemolytic anemia.
My hemoglobin is low, reticulocytes high. Other numbers off, too.
My iron and folic acid are in range but he wants me to take iron QOD.
I’ll have another echocardiogram.
Two cardiologists I’ve seen here have said another surgery is not an option for me.
My mitral valve also is leaking mod to severe,after repair in 09, but cardiologist thinks it’s the aortic valve. Previous echos don’t show a problem with aortic valve function.
I’ll reach out after my echo. Thanks everyone!
 
If I recall correctly from 2011, I'm pretty sure I remember the hematologist telling me that taking iron won't really address the issue. My daughter ended up having regular transfusions (every 3-7 days) for a couple of months until she achieved what was termed a state of 'compensated hemolytic anemia.' In other words, the shearing didn't end, but her body eventually adjusted to the hemolysis, and her bone marrow was able to adjust accordingly to making new red blood cells. Her third heart surgery in 2014 was due to a severely leaking mitral valve, not the hemolysis. All the best.
 
She’s gone thru a lot for her young years.
Was her mitral repaired w anulplasty ring?
My high results: MCV, MCH, RDW, lactate dehydrogenase, reticulocyte. Low:RBC, Hemoglobin, hematocrit, MCHC.
 
My mechanical valve is shearing my blood cells. My blood numbers have been going down since 2018. My newest cardiologist thought my valve is probably the culprit. I started seeing a new GP and asked her to check my blood.
Everything was off, so she sent me to a hematologist. More blood tests ordered and one was crazy high. ( lactate dehydrogenase-1660).
He called my cardio and was told I can’t have a 4th surgery so do what he can for my blood. I am now on Trental 3 times a day and he hopes it will trend my numbers up. I am concerned to say the least.
Gail,
I sure hope they get to the bottom of it 🙏🙏have you have 3 previous valve surgeries ? I’ll say a prayer for you . If you are the praying kind , I love praying the St. John of God .. the patron saint of heart disease
 
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I’ve had 3 surgeries in 20 years. It’s been 14 yrs since my 3rd surgery.
I didn’t know there was a patron saint for heart disease. I’m a Lutheran, so am open for prayer!
 
She’s gone thru a lot for her young years.
Was her mitral repaired w anulplasty ring?
My high results: MCV, MCH, RDW, lactate dehydrogenase, reticulocyte. Low:RBC, Hemoglobin, hematocrit, MCHC.
Your blood results are exactly what she experienced. The surgeon did not use an annuloplasty ring when he performed her mitral valve repair. Apparently, I believe the use of the ring is implicated in blood shearing, so the fact that she developed hemolytic anemia in the absence of any such device was rather unusual.
 
I was anemic and for four and half years I took iron supplements. Luckily one of my doctors tested me to see how iron I had in my body. I had triple the amount that is needed. If it gets to high you can have organ failure. After I had my aortic valve replaced with a tissue valve I am no longer anemic. It took about 2 and half years for my iron level to get down to a normal level.
 
Your blood results are exactly what she experienced. The surgeon did not use an annuloplasty ring when he performed her mitral valve repair. Apparently, I believe the use of the ring is implicated in blood shearing, so the fact that she developed hemolytic anemia in the absence of any such device was rather unusual.
Any proof of that? never heard of such a thing.
 
"regurgitant jet striking the annuloplasty ring" - there is no "jet" - at least not like a jet associated with mechanical valves. There is flow but that doesn't seem to me that that would cause blood shearing.
 
Even though my repaired mitral (anulplasty ring) is leaking mod to severe, I made a point of asking if it was my mitral or aortic valve causing this blood issue. My cardiologist said he thinks it’s the aortic valve. I have an echo and another appointment in July. So I’ll have more questions and answers then.
 
Pretty much same problem here. My HGB, HCT, RBC has been declining for about 2 years. LDH is high, ferritin normal. (OHS in 2017 replaced tricuspid, aortic and mitral valves, the latter two are mechanicals). I was able to get on Aranesp when HGB hit 9.6 even though I've been symptomatic (SOB and exhaustion mostly) ever since HGB dropped below 13.0. Had four doses so far and HGB is back up to 11.2 mg/dL. Three days ago I got a TEE and results show a significant paravalvular leak around the bottom 6 o'clock of the mitral valve and indeed there is a 'jet' shooting some blood back into left atrium; blood that should be going out the aortic valve. That is probably what's causing most if not all of the hemolysis as the hole is irregular and probably shearing cells as they are forced through. There is also a smaller insignificant leak at 9 o'clock, although I personally don't consider any leak 'insignificant'.

Plan is to repair it via a transcatheter plug but specifics are being debated by my cardiologist and a team of experts. I guess there is more than one way to do it. They will first need higher resolution imaging like a CT scan to see exactly what the defect looks like.

I would think they will need access to both sides of the leak meaning they will be working from the atrium side as well as the ventricular side. Duct tape on one side and bubblegum on the other.
 
My HGB is now 9.4. Hematologist said if it goes down to 7 then I would be needing transfusions weekly. But, he’s hoping that won’t happen. He added folic acid 1 mg to my regimen. Never mentioned aranesp.
I need to ask cardiologist if he wants a TEE in the future. I won’t see him til end of Aug, now, along with echo same day.
At least you are a candidate for another surgery to fix this for you. That’s good!
All the best!!!
 
Thanks, I hope it won't require another surgery. The plan is to go in through a vein to deploy the plug.

I was told the threshold for transfusion was hematocrit of 25% or below. (I was as low as 28% where normal for adult male is 38% - 50%). 25% means one has about half the RBCs a normal person would have. That's pretty bad and the fact that they withhold transfusions until someone is that bad, I think, shows what a shortage there is in the blood supply.

I'm on folic acid too. I had to ask for Aranesp. In fact, I went to the emergency room to get it but was told I didn't qualify because my HGB wasn't low enough (basically, go home and get sicker). When my hematologist opened an appointment slot due to a cancellation (I would still be waiting for an appointment otherwise), she said, no, the threshold for Aranesp is HGB <= 10.0, and immediately prescribed it for me. I got the first shot (200 mcg starter dose) that same morning. It's a regular injection every two weeks but I got them to advance me to one every week. My third and fourth shots were bumped up to 300 mcg. It has improved my HGB to over 11 and that's the cutoff, I think determined by insurance company's willingness to pay, since they consider 11 good enough. To be fair, I read that the original trial was done on patients with chronic kidney disease and when they tried to continue Aranesp on patients with HGB at 11 and higher, patients suffered from adverse events (clots) so they stopped trying to improve any further and just recommend its use for HGB at 11.0 or below. Now those of us on warfarin are at reduced risk of clots but that is not part of the calculus, evidently.

If I were you I would ask my physician about Aranesp, generic name: darbepoetin alfa. It's a synthetic erythropoietin (EPO), the natural hormone produced by the kidneys when they sense low oxygen (hypoxia) in its cells. The hormone stimulates the bone marrow to produce more red blood cells, which of course carry the hemoglobin which carries the oxygen our bodies need. Actually the bone marrow manufactures reticulocytes, which are immature red blood cells that take a while (1-2 days) to mature. The doctor will order reticulocyte count (normal 0.7% - 2.8%) because a high count in an anemic patient is a sign that the system is working properly and the bone marrow is producing its expected high output of new cells trying to make up for the anemia. Mine went as high as 6.9% after the Aranesp injection from as low as 1.2%. It's also possible to measure EPO directly. It's only been done once with me at 33.1 (normal: 2.6 - 18 mU/ml) prior to any Aranesp; so it was already elevated naturally by the kidney sensing low O2. My hematologist said that she has seen patients with EPO measured as high as 1800 when I asked her, if Aranesp was going to overly tax the bone marrow RBC production capacity. So there is abundant margin between 33 mU/ml and 1800 mU/ml for Aranesp to work. BTW, wikipedia says EPO can get as high as 10,000 mU/ml! That's some high-octane blood!

Good luck.
 
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