Blood breaking down from heart valve

[Shirley Dickey]

curious has anyone else had their red blood cells break down due to mech valve.. I have been sent to a hematologist cause my hemaglobin is down in the 7's forgot number it has been falling every since my surgery which has been almost a year ago and iron supps just arent working like cardio or pcp was expecting. Seen hematologist and had a full blood work up and they said that my blood cells is being sheared off as it pass the heart valve forgot the name of the type of anemia it is causing..so will be starting blood transfusion and iron infusions sometime this week..dr said i will have to have it done several times a year if i plan on keeping the mech heart valve..any one ever hear of this or have any experience with it...
Thanks for any reponse

 

[CATDOG]

Shirley,
I have read that once before, but didn't know whether it was a flukey thing, internet dramatization, etc.
So you have an On-X valve that is doing that in the mitral position? Does your dr think it is working properly otherwise?
Is your hematologist looking to rule out some kind of other problem that is making your red blood cells weaker than usual? Or does this happen with everybody to varying degrees, and you just have it a little worse on the continuum of normal?

I thought the On-X was supposed to have less of this due to the leaflets opening closer to 90 degrees. Did the dr mention anything about valve size or position or rotation in relation to this problem? Is there any leakage around the valve where the damage could be happening, or do they think it is the lead-edge of the leaflets that does the chopping?

CatDog

 

[Lily]

I recall reading about a few members who have dealt with this issue, lysing, though that is the abbreviated word for it. Ah, just remembered it's called hemolysis. You could search this site, either threads and/or posts, using that word. Hope you find some answers. I have an older relative who was told that their native malfunctioning aortic valve might have been doing that to them but the doctors weren't sure about it. The relative later received a bovine valve and I think the lysing problem stopped for them. (That's really not helpful to you in any way but I'd never before heard of the possibility of a native valve causing that issue.)

 

[RBCola]

Hey Shirley,

Its called hemolytic anemia. Its common with mechanical valves or stenotic valves. As the blood pumps through the valve, basically it disrupts the membrane of the red blood cell and cause them to lyse (break). Best case scenario is after they transfuse you and get your hemoglobin back in the normal range, they can just supplement your with oral iron. Hopefully, on the iron your body will be able to balance production of red blood cells with their destruction and keep you in a somewhat normal range requiring no blood transfusions.

-RBCola

 

[Eva]

Shirley,

Here is one of the threads discussing hemolysis: http://www.valvereplacement.org/for...ount-and-Mechanical-Valve&highlight=Hemolysis

My sister took iron pills for a year with no benefit until a relative recommended VITRON C, which was the only iron pills that improved her blood. It worked like a miracle! Now, i take it four times a week and i feel better on those days. I recommended it recently to an older woman who was not benefitting from her iron pills either... it worked for her too.

I strongly recommend you give it a try for three months and do a blood work.

Good luck, and keep us posted.

 

[kfay]

As others have said, it has come up on here several times. I know of someone who has it who has mechanical aortic and tricuspid valves. She takes iron daily and receives transfusions on a regular basis (not sure if it is once a quarter, but that's how often I want to say). I know that by the time she needs the transfusion again she is very lethargic, but feels so much better afterwards. I think this will be her treatment as long as she lives.


Kim

 

[Bill B]

Hemolytic anemia happens with mechanical valves as RBCola described. It's almost always subclinical (not severe enough to be noticed), with only about 3% of mechanical valve patients developing moderate to severe anemia, as you appear to have. The On-X valves are claimed to be less prone to causing this than other valves, but there are no published studies to support that claim. Your hematologist will confirm that the anemia is due to hemolysis and not some other cause. Iron replacement is important, and some formulations that include vitamin C are better absobed in some people as mentioned.

These papers might be relevant...significant hemolytic anemia with mitral valves is associated with regurgitation.

http://content.onlinejacc.org/cgi/c...d3d1bdf14928b8d2b85ea051&keytype2=tf_ipsecsha

http://jtcs.ctsnetjournals.org/cgi/content/full/123/3/550

 

[Julian]

B Bill your the freaking man!

 

[epstns]

IIRC, Nancy may be a resident expert on this one. I think I remember that Joe also had this from time to time, and Nancy became adept at recognizing the situation and securing proper treatment for him.

 

[Rebecca]

For the last four years I have been anemic (HCT) and my blood count has always been low (mostly red blood cells). I was put on prescription iron for three and half years. I am not sure when they started testing my blood for Ferritin. But my level was in the six hundreds and I was still anemic. The normal range is 13-150. My hematologist told me she thought my damage valve was causing my anemia. Make sure that they test your Ferritin levels because I had toxic level of iron in my blood. Too much ferritin in your blood will make you tired and muscle bone ache. At 1000 level you suffer from kidney failure. At my six month visit after surgery with a tissue valve all of my blood works is normal, but my ferritin level was at 434. After taking iron for many years I figure it will take time for my iron level to go down to a normal range.

 

[Shirley Dickey]

Thanks for all the info..raises more questions for me to ask the hematologist...I know he pulled about 7-8 vials of blood and said he waas going to test for everything then explain the results at the next appt..before he does anything...i just want to have my energy level back...to tired to even do much fishing and i love to fish more than anything..

 

[sarahsunshine]

Sorry to hear you are having problems with hemolytic anemia. Had all sorts fo questions about this before step son's surgery since he now has 2 on-x valves (mitral and aortic). Definitely a concern.

Personally I have had the best success with Hemaplex - an over-the-counter iron supplement that is made of natural ingredients and therefore easier absorbed. It also doesn't have many of the unpleasant side effects that other iron supplements have (green poops, constipation). Just another type to consider!

 

[TheGymGuy]

Hemolytic anemia happens with mechanical valves as RBCola described. It's almost always subclinical (not severe enough to be noticed), with only about 3% of mechancial valve patients developing moderate to severe anemia, as you appear to have. The On-X valves are claimed to be less prone to causing this than other valves, but there are no published studies to support that claim. Your hematologist will confirm that the anemia is due to hemolysis and not some other cause. Iron replacement is important, and some formulations that include vitamin C are better absobed in some people as mentioned.

These papers might be relevant...significant hemolytic anemia with mitral valves is associated with regurgitation.

http://content.onlinejacc.org/cgi/c...d3d1bdf14928b8d2b85ea051&keytype2=tf_ipsecsha

http://jtcs.ctsnetjournals.org/cgi/content/full/123/3/550

Bill, I am blogging this for easier search later. Way to educate and provide references. Thank YOu!!!

 

[coffeelover]

Bill,
Thanks for posting the papers about hemolytic anemia. I was not aware of this condition--definatley something valvers with mechanical valves need to be aware of.

 

[coffeelover]

Does anyone know if blood pressure is a factor in hemolytic anemia? In other words, does a higher BP create more problems/does a lower BP make a difference in decreasing the effect on RBC? Is this a factor in having trace RBC show up in urine labs? Just curious.....

 

[Shirley Dickey]

Seen hematologist yesterday , and the blood work I had done shows that I am an oddball ...
Dr said in his words that my iron stores, b12 and folic are crap!!! so i will be getting an iron infussion and b12 shots along with taking folic acid..He said i am definately hematolyic? anemia and that blood cells do show some shearing and are showing signs of hemolosis? he believes to be from the on-x valve and he is now testing me for something called Von Willebrand diease , he thinks that between the valve and the warfarin something is going on in the blood and in his opinion there is a strong possibility that I will have to have the mech valve taken out and replaced with a tissue valve do to the treatment for von willebrand is not something he would want to continue thru my lifetime when in is opinion problems will most likely resolve them self when mech valve is replaced.but before the decision is made we will wait on the recent test results.
So question is has anyone heard of Von Willebrand disease and electrophoresis (another test he ordered)
I have done a lil research on it but find it very hard to understand and unfortunaley dr always explain things in dr terms not patients terms so that we understand, He tried to explain them several times but I could not grasp what he was trying to explain so any info would be appericated...
Sorry for all the misspelled words I am not that great of a speller as you can tell...
Thanks for all the replies and have a good day

Really not looking foward to a 4th OHS..out of the 3 I have had they have not been easy and something always went wrong..I try not to talk about or post much about it cause I dont like freaking new people outwith the scary details because I am such an oddball that even the dr says i am not in the normal OHS statics.....

 

[AgilityDog]

Yes, Von Willebrand's Disease is common in Doberman Pinschers! Not to compare you to a dog. But you can google it. But it is my understanding it is a genetic ailment, which may be complicated by you having a mech valve.

"What Is von Willebrand Disease?
Von Willebrand disease (VWD) is a bleeding disorder. It affects your blood's ability to clot. If your blood doesn't clot, you can have heavy, hard-to-stop bleeding after an injury. The bleeding can damage your internal organs. Rarely, the bleeding may even cause death.

In VWD, you either have low levels of a certain protein in your blood or the protein doesn't work well. The protein is called von Willebrand factor, and it helps your blood clot.

Normally, when one of your blood vessels is injured, you start to bleed. Small blood cell fragments called platelets (PLATE-lets) clump together to plug the hole in the blood vessel and stop the bleeding. Von Willebrand factor acts like glue to help the platelets stick together and form a blood clot.

Von Willebrand factor also carries clotting factor VIII (8), another important protein that helps your blood clot. Factor VIII is the protein that's missing or doesn't work well in people who have hemophilia, another bleeding disorder.

VWD is more common and usually milder than hemophilia. In fact, VWD is the most common inherited bleeding disorder. It occurs in about 1 out of every 100 to 1,000 people. VWD affects both males and females, while hemophilia mainly affects males."

 

[dtread]

Shirley, I reviewed your post with interest as I have an On-X valve, although in the five years I've had my valve it has functioned flawlessly and I have not had any problems with anemia (or any other problems, for that matter). And I am very active and work out in the gym regularly, ride my bicycle, etc., and eat primarily vegetarian food (I eat fish once or twice a week). My carnivore friends seem to always be concerned about inadequate protein intake if they switched to a vegetarian lifestyle, but it hasn't been a problem for me. However, I was interested enough to contact the On-X company and they told me the following:

1. Most cases of extreme hemolysis are caused by paravalvular leak—the seal around the valve is not complete—a small gap in between the valve sewing ring and the tissue allows regurgitation at high pressure to shear blood cells. The cause for the gap can be calcium deposits, poor tissue quality, infection and/or not enough sutures (not usually). It is rare to see the actual valve itself proven to produce clinically significant hemolysis—blood damage that requires replacement of the valve although there are a few reports of this in the surgical literature (not with the On-X valve). This can happen with tissue valves as well.

2. Paravalvular leak is not a common complication (<1%) and is usually small enough to disappear after surgery. But some are too large and cause this excess hemolysis.

3. All mechanical valves cause some level of “normal” hemolysis mainly due to turbulence within the valve structure.

They referred me to the following study from the Journal of Heart Valve Disease, Volume 9, No. 1, January 2000, pages 142 - 145. Here is the abstract:

http://www.icr-heart.com/journal/extconjan00/Examination of Hemolytic.htm

Examination of Hemolytic Potential with the On-XR Prosthetic Heart Valve
Dietrich Birnbaum MD, Axel Laczkovics MD, Martin Heidt MD, Hellmut Oelert MD,Günther Laufer MD, Hans Greve MD, Jose L. Pomar MD, Friedrich Mohr MD,Axel Haverich MD, Dieter Regensburger MD

Mechanical valves are known to produce chronic, subclinical hemolysis in most patients. The On-XR prosthetic heart valve was studied for hemolysis using standard blood parameters in isolated aortic and mitral replacement in a 10-center trial. A central clinical laboratory was used to ensure poolability of data. Results showed a decrease in serum haptoglobin and an increase in serum lactate dehydrogenase (LDH) (as is typical with mechanical prostheses). The increase was greater in mitral valve patients than aortic valve patients, but still within the normal range in most cases. Levels of blood damage for the On-X valve were lower than those reported for other mechanical valves, and hemolytic anemia did not occur with this valve.

Also this provides additional information: www.onxlti.com/2005/01/clinical-update-thirteen/

If you want additional information you can contact the On-X representative, Catheran Burnett, at [email protected] or phone 888-339-8000 x265

 

[Eva]

......

So question is has anyone heard of Von Willebrand disease
..............
Thanks for all the replies and have a good
....

Shirley,

Here is an quote from Mayo Clinic: http://www.mayoclinic.com/health/von-willebrand-disease/DS00903

quote
........

The cause of von Willebrand disease is a deficiency in or impairment of a protein called von Willebrand factor, an important component in your blood clotting process. In general, it takes longer for people with von Willebrand disease to form clots and stop bleeding when they're cut.

Treatment of von Willebrand disease focuses on stopping or preventing bleeding episodes, typically by using medications.

With the right treatment, people with von Willebrand disease can lead normal, healthy lives.
Unquote

VERY TRUE! My Father-in-Law discovered he had this "Von Willebrand disease" when he was in his mid-twenties. He did live a better than any one else's normal life until he passed away last August at age 89. He was very active, with an extremely sharp brain and memory till the end, travelled all over the world, and literally walked 5 miles every day until the last five years ... He walked 2 miles only! He never accepted to have a still moment!

He could have easily still been around walking and joking and living if he had followed his doctors' recommendations five years ago!

Good luck and keep us posted.