Low red blood count? What's happening

[cp172]

Hi Guys,

I had mitral valve repair on Feb.7th of this year. In the last three weeks I have visted my surgeon, cardiologist and recently my physcian. Blood pressure, valve operation, etc are all fine.I feel fine. Last week I received a call from my physcian who said that my blood test indicated I was slightly anemic and he wanted me to under more blood test. Today I received a call from him and he said that my Haptoglobin test indicated my level was below normal.He explained that the test indicated I did not have an iron deficency but that my red blood cells were being damaged. He is recommending I visit an oncologist. I plan to call my surgeon tomorrow to see if this is a side effect of surgery. Has anyone else had something like this? The only thing I have seen different is that my urine is darker than I remember it being. I would appreciate any comments. Thanks as always for being there.

 

[Nancy]

My husband was under the care of an oncologist/hematologist. Some oncologists have a dual discipline. Joe's initial diagnosis was hemolysis of his blood cells from his older model aortic mechanical valve. He also had a St. Jude mitral replacement.

He was put on prescription strength Folic Acid, iron, and eventually ProCrit injections three times per week which I gave him. It did help.

But there were times when even all of that wasn't enough and he had to have transfusions, and on occasion iron IVs.

His problems may be different than what yours are, but wanted to let you know that this kind of problem can exist with valve people.

Later on in life, Joe's kidneys started to fail, and that increased his anemia. And then he developed GI tract bleeding from an irritation of the lining in his stomach and GI tract, from what?? I don't know. He did have argon vapor cauterization to try to minimize it.

There are many reasons for anemia, and a hematologist/oncologist is the right discipline to help you. There are things that can be done.

Wishing you all the best.

 

[cp172]

Nancy,

Thanks for the information. Its good to have you ready to help with questions. I hope you are staying warm

 

[Bina]

Maybe Nancy remembers......we have a woman member who has commented on her condition: her valve is possibly bashing up her red blood cells...??

 

[kfay]

Bina, I was thinking the same thing. Can't remember who it was though. But CP had a repair, can that do that as well?

Kim

 

[kfay]

Found her...djacq...she has hemolysis from her new valve damaging her blood cells. I think I read about someone else. Again, I'm not sure if this is applicable here since you had a repair. I hope everything checks out for you.

Kim

 

[Ross]

No, not applicable to repairs, only mechanical replacements.

 

[djacq]

Hi Cp,

I have both hemolytic and iron deficiency anemia. My haptoglobin is 7 (norm 43-212) and my LDH is 205 which indicates damage. Hgb has been as low as 9. Iron is 30 and they want it at 100.

I am seeing a Hematologist who is trying to find the source of a bleed and destruction. This has been going on for months. I have had a GI work up and my cardio did an echo and said my valve was working fine but does that mean it is not casuing hemolysis? I do wonder if blood squeezing through my other leaky valves is damaging my red blood cells. I may make an app't with my cardio to explore this further and see if he has any ideas.

I am supposed to get a Urology work up. My GYN ultra scans were fine.

I have been told that they may never find the cause. I have to think about swallowing a camera in a capsule and wear a monitor for a day to check out the small bowel. This is a long shot and not too happy about going on clear liquids for 2 days for this new procedure!!!

As you will see, the process of finding out why you feel so bad while you are feeling so bad can be overwhelming.

If your urine is dark, I would start there. Nancy is right about seeing a Hematologist. She referred me to G I am now thinking of getting another opinion as she dosen't even want to see me for a few months. I am on iron three times a day with folate. Through info here, I added B12.

I am anxious to see how things turn out for you. Please let us know. I will also let you know if I get any new info. It seems to be a process that can be a mystery and I may never know the cause.

Good luck,

~donna

 

[cp172]

Thanks Bina, Kim, Ross and Donna:

I obtained my blood work today. Here are the results outside of normal ranges:

Test...................Result........................... Normal Range
Iron Saturation.......14 low....................15-55
Ferritin Serum.........18 low....................22-322
Haptoglobin............<10 low......................34-200
Reticulocyte count.....3.9 high.................... .5-3.0

I called my surgeon's office and they want to see me after the holidays. After that my doctor has arranged an appointment with a hemotologist.Yes my urnine is dark yellow. Good news is I do not feel bad and did not know I had a problem. I hope you all have a Merry Christmas.

 

[cp172]

Donna,

Best of luck to you in finding out what is causing your problem. Maybe we will both get quick, easy fixes in 2009!

 

[briansmom]

My son has been anemic since the beginning of all this. In fact, that was the first thing the doctors noticed. He saw a hematologist/oncologist. Your numbers don't look horrible so hopefully it will turn out to be nothing. Did you have any kidney function tests done, like a BUN. I know they told you your were not iron deficient and that your cells were damaged, but they told my son the same thing for 2 years and the only thing that really helped him was IV iron. Do you eat red meat? Take some extra iron while you are waiting to see your doc. Drinking OJ with iron helps with absorption.

 

[ALCapshaw2]

Hi Cp,

I have both hemolytic and iron deficiency anemia. My haptoglobin is 7 (norm 43-212) and my LDH is 205 which indicates damage. Hgb has been as low as 9. Iron is 30 and they want it at 100.

I am seeing a Hematologist who is trying to find the source of a bleed and destruction. This has been going on for months. I have had a GI work up and my cardio did an echo and said my valve was working fine but does that mean it is not casuing hemolysis? I do wonder if blood squeezing through my other leaky valves is damaging my red blood cells. I may make an app't with my cardio to explore this further and see if he has any ideas.

I am supposed to get a Urology work up. My GYN ultra scans were fine.

I have been told that they may never find the cause. I have to think about swallowing a camera in a capsule and wear a monitor for a day to check out the small bowel. This is a long shot and not too happy about going on clear liquids for 2 days for this new procedure!!!

As you will see, the process of finding out why you feel so bad while you are feeling so bad can be overwhelming.

If your urine is dark, I would start there. Nancy is right about seeing a Hematologist. She referred me to G I am now thinking of getting another opinion as she dosen't even want to see me for a few months. I am on iron three times a day with folate. Through info here, I added B12.

I am anxious to see how things turn out for you. Please let us know. I will also let you know if I get any new info. It seems to be a process that can be a mystery and I may never know the cause.

Good luck,

~donna

Donna -

Are you drinking enough Water?

Urologists like you to drink enough water so that your urine is clear or almost clear.

The other side of that issue is excess fluid retention which can put an extra load on your heart.

Daily weighing in your birthday suit (or undies) helps to keep track of weigh gains / losses due to fluids.

 

[tobagotwo]

This is from an earlier thread, that was actually about a xenograft (tissue valve) causing a similar problem. Please use the Search/advanced search function to look up homolysis. There are a number of threads about it, and Nancy and others have weighed in on this subject before:

This problem is usually called hemolytic anemia, but it's sometimes also termed as mechanical hemolytic anemia, hemolysis, or microangiopathic anemia. Mechanical in the name refers to the mechanical action that causes the red blood cells to be damaged, and is not a description of the valve type.

Tissue valves don't usually damage a significant number of red blood cells, but there are cases where it happens. There are even cases of repaired, original mitral valves causing this problem. So even your own, native flesh is not entirely safe post surgery. (For the curious: www.nv-med.com/atcs/pdf/2005_11_3/198.pdf)

Here is a typical appraisal of post-VR anemia risk:

Hemolytic anemia following insertion of Ionescu-Shiley mitral valve bioprosthesis S B Reddy, J L Pater, J Pym, and P W Armstrong http://www.pubmedcentral.nih.gov/art...?artid=1440344
"Hemolytic anemia is a relatively common complication after the replacement of cardiac valves with mechanical prostheses; the prevalence rate varies from 38% to 85%, depending on the prosthesis implanted. However, cardiac valves fabricated from biologic material are associated with a reduced incidence of hemolytic anemia..."

When it does happen in biological valves, frequently there are other factors involved that make the red blood cells involved more fragile. However, it isn't much comfort if they're your red blood cells.

As things progress, the numbers for mechanical valves have gone down, as the current-generation carbon valves (e.g. On-X, Sorin, ATS) have much softer, erythrocyte-sparing closures than the last generation of mechanicals."

Even the older St. Jude Regent has a much lower rate of hemolysis than the original replacement valves. It affects a relatively small portion of replacements, but is not a thing of the past, as some people have been touting.

It may very well be that your physician is unaware of this phenomenon, and that you might want to see a hematologist before trying an oncologist (an oncologist will likely concentrate on looking for cancer, rather than for an overzealous valve). This may be good news for you, inthat it gives a very plausible and likely explanation alternative to leukemia, but it's still a significant and stubborn issue on its own.

Best wishes,

 

[cp172]

Thanks Deanne, Al and Bob,

They did run a "BUN". My result was 12 with an acceptable range of 7-18.I seldom eat any red meat but am now increasing the cow intake.I am also taking a vitamine with iron. I was able to get copies of my blood work 4 months after surgery and everything was fine.The only change between blood tests has been the enormous amount of work related stress I am under which is unlike anything I have every seen.I think I have that problem under control.I hope you all have a wonderful Christmas.

 

[catwoman]

I've had hemolytic anemia since my surgery. Been disagnosed with paravalvular (sp?) regurgitation. I take 1,000mg of B-12 daily (which is about 17,000 -- yes, 17,000 -- daily RDA for B-12). This seems to help keep it in check.

As far as BUN stats:

I don't know how BUN & createnine (sp?) equate in humans, but createnine is a more accurate measurement of kidney function in cats. BUN can increase/decrease quicker than createnine.
In 1994, we had an Abyssinian with kidney failure and we had to check his BUN & createnine frequently, as well as PCV (packed cell volume, or hematocrit). My vet put more stock in the createnine than the BUN.
Since then, I've always looked to the createnine numbers on lab results, rather than BUN.

 

[cp172]

Catwoman,

My creatinine was 1.0 with normal range being .6-1.3. Thanks for the info.

As you can see my wife and I also love cats. We have two inside and three outside.They are a hoot to watch.

 

[ALCapshaw2]

Even the older St. Jude Regent has a much lower rate of hemolysis than the original replacement valves. It affects a relatively small portion of replacements, but is not a thing of the past, as some people have been touting.

It may very well be that your physician is unaware of this phenomenon, and that you might want to see a hematologist before trying an oncologist (an oncologist will likely concentrate on looking for cancer, rather than for an overzealous valve). This may be good news for you, inthat it gives a very plausible and likely explanation alternative to leukemia, but it's still a significant and stubborn issue on its own.

Best wishes,

Bob H -

What do you mean by your comment
"Even the older St. Jude Regent has a much lower rate of hemolysis than the original replacement valves."

The St. Jude Regent is their Latest Model Valve for the Aortic Position. Did you mean to say "Even the *NEWER* St. Jude Regent ... ?

I'm still trying to find when it was introduced (after viewing several pages of Google Links) but haven't found a date of introduction. My 'gut feeling' is that it was 'after' the introduction of the On-X valve in 1996.

 

[Eva]

Bob H -
.................The St. Jude Regent is their Latest Model Valve for the Aortic Position. Did you mean to say "Even the *NEWER* St. Jude Regent ... ?

I'm still trying to find when it was introduced (after viewing several pages of Google Links) but haven't found a date of introduction. My 'gut feeling' is that it was 'after' the introduction of the On-X valve in 1996.

Hi Al,
Does 1999 sound right: Here is an exerpt from SJM Newsrelease website?
QUOTE:
05/10/99 St. Jude Medical Begins U.S. Clinical Evaluation of SJM Regent Mechanical Heart Valve UNQUOTE

Website: http://phx.corporate-ir.net/phoenix.zhtml?c=73836&p=irol-news&t=Search

 

[cp172]

Well I went to my surgeon today.He reviewed my blood work and said that the mitral valve repair has nothing to do with my anemia (destruction of red blood cells). He said the surgery still looked good and that the hemotologist would have to figure out the problem.He said he had only seen one case of anemia caused from a repair and it had to do with the ring coming loose and allowing a stream of blood to flow through the tear.

I am scheduled to see the hemotologist next week so I guess I will know more then.At least I know its not the mv repair. Hope you are all well.

 

[djacq]

Glad to hear your repair did not cause hemolysis. Looks like we are still in the same no where place. I am on a vacation from Dr's, tests etc for the holidays. I got too tired and discouraged. Large doses of iron are keeping me going and I am still fearful of an iron infusion due to my history of allergic reactions.

I think I will follow your case and diagnose myself vicariously through you if you don't mind keeping us updated. So I am anxiously awaiting what your hemo doc has to say as mine believes it is my cardio's problem. He says my valve is fine. Thinking of a 2nd hemo opinion this year.

Good luck and will be thinking good thoughts this will resolve itself for you as I am told may happen or you may never find the cause. At least that is what my hemo doc told me. Lets see what info you get.

donna