Symptomatic anaemia 17 years after double valve replacement

Wong MH, Chee KH, Azman W 
Correspondence: Dr Wong Mun Hoe, drwongmh@gmail.com

ABSTRACT
A 40-year-old Malay woman presented with increasing lethargy, palpitation and shortness of breath, 17 years after a mitral and aortic valve replacement. A Starr Edwards prosthetic valve replaced the mitral valve, and a Bjork-Shiley prosthetic valve replaced the aortic valve. Biochemical parameters demonstrated intravascular haemolysis, as evidenced by haemoglobin 7.8 g/dL, reticulocyte count 8.4%, lactate dehydrogenase 2,057 IU/L and low haptoglobulin levels (less than 6 mg/dL). Transoesophageal echocardiography revealed a paravalvular leakage over the mitral valve. The haemoglobin levels remained persistently low despite frequent blood transfusion. She successfully underwent a second mitral valve replacement. Her anaemia resolved A subsequently.

Keywords: anaemia, haemolysis, haemolytic anaemia, paravalvular leakage, prosthetic valve
Singapore Med J 2009; 50(10): e362-e364