Mild anemia after AVR with a mechanical valve

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RunMartin

RunMartin

VR.org Supporter
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Joined
Oct 20, 2003
Messages
310
Location
Pendle Hill, North West, England
Has anyone with a mechanical aortic valve noticed they are mildly anemic after surgery.

My valve was replaced over 9 years ago and it became obvious soon after that I found the hills much more difficult to run up and I was at least a minute a mile slower of the flat.
It is not noticeable with normal day to day activities.

I was told soon after surgery I was slightly anemic and have been taking Ferrous Fumarate ever since. I mentioned this to my cardiologist at the time but they were not interested.

I have just had the results of my yearly blood test. Again my blood levels were down as usual 125 g/L for Haemoglobin estimation (should be between 130 and 180). It was 140 pre surgery.
The doctor said this is equivalent to a loss of one and a half pints of blood which would explain why I so much slower.

This time the doctor I saw is one who really knows how much exercise I do as he sees me at my gym when I go for my morning mile swim. He has decided to look more into this with further blood tests which is a good step forward.

When I got back from the doctors I found this article on the Internet which would imply that red blood cells are damaged by the new prosthetic heart valve

https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.4960210604

"Mechanical trauma to red blood cells is the primary cause of hemolytic disease in patients with prosthetic heart valves"

Has anyone else noticed their performance changes post AVR?

Martin
 
Yes

There is an older thread about confusion that sort of links this too, i shall try to find it.
Up until recently i would define my cardio routine as chronic

Since my surgery my haematocrit is always low ; latest result .38 ( 0.4 - 0.54 LL)
Red blood cell count 4.3 ( 4.5 - 6.5 )
I looked into haemodynamics around the mechanical valve and it suggests that
it damaged cells.
Interestingly when i do excessive cardio my warfarin dosage needs to drop , i attribute this to having less red blood cells.
Now that i have reduced the amount of cardio the warfarin dosage has increased by 3mg per day to maintain the same INR

I am interested to see my next blood work results
 
Thanks for your reply.
It is good to know someone else has noticed the same thing. I have felt this was the cause of my change in athletic performance several years ago. I did ask the questions on this forum soon after my AVR but no one else could back it up.

I notice you had your AVR at the same time as myself. Did you go to Wythenshawe?

I will keep you posted on the blood tests results (blood test is in a weeks time)
 
Yes i did, Paul waterworth & his team did the surgery

I presume you did too being from Pendle ?

I cycle that hill a lot, i reckon you run it regularly as well 😄
 
Yes, I take Ferrous Fumerate too. Fortunately I was doing a clinical trial for a cholesterol drug soon after my heart surgery, and they do blood tests for absolutely everything and picked up my mild anaemia. Another two pills to add to my daily collection.
 
Yes, I became highly anemic. One day, I was so very tired that I knew something was wrong. My blood test revealed an iron level of 7 when my doctor said it should be more like 180-200. I started iron pills (Vitron C) and it eventually improved. In my case, I think it was all the blood I was losing during my monthly cycle (tmi but it was like a murder scene!). At that time, however, I read the same articles about the valve damaging blood vessels. My iron levels have improved, so I only take the pills a few times a week. I’m sure my diet didn’t help (I hate red meat) but that has been consistent my entire life, so I suspect it was all the blood loss combined with the damaged cells that caused my anemia.
 
LondonAndy said:
Yes, I take Ferrous Fumerate too. Fortunately I was doing a clinical trial for a cholesterol drug soon after my heart surgery, and they do blood tests for absolutely everything and picked up my mild anaemia. Another two pills to add to my daily collection.
Click to expand...
Hi Andy. Do you mean you take two iron pills a day? I went down to one and started looking pale, so I went up to two again.
 
Hi
leadville said:
Now that i have reduced the amount of cardio the warfarin dosage has increased by 3mg per day to maintain the same INR
Click to expand...
that's interesting as I'm not sure how the clotting factors (which infuence INR) would be damaged by the same physical forces which damage the red blood cells.

Now, this isn't to say it doesn't (or even to discount your observation) but its interesting.

LondonAndy said:
Yes. My Cardiologist said it is not unusual for mechanical valves to damage red blood cells as they pass through.
Click to expand...

and just to add to this, platelets too IIRC
 
fun reading to extend the articles referenced in that above post mentioned by @leadville :
https://en.wikipedia.org/wiki/Fibrin

this discusses the concept in general of damage
https://www.ncbi.nlm.nih.gov/pubmed/17725695

for those of us who are sportingly active the elevated HR may indeed contribute significantly to the damage of large blood borne molecules. (like hemoglobin and platelets).

Ultimately the answer is: test and understand and act to correct that (be that higher intakes of iron, warfarin or burbon)
 
RunMartin said:
Has anyone with a mechanical aortic valve noticed they are mildly anemic after surgery.

My valve was replaced over 9 years ago and it became obvious soon after that I found the hills much more difficult to run up and I was at least a minute a mile slower of the flat.
It is not noticeable with normal day to day activities.

I was told soon after surgery I was slightly anemic and have been taking Ferrous Fumarate ever since. I mentioned this to my cardiologist at the time but they were not interested.

I have just had the results of my yearly blood test. Again my blood levels were down as usual 125 g/L for Haemoglobin estimation (should be between 130 and 180). It was 140 pre surgery.
The doctor said this is equivalent to a loss of one and a half pints of blood which would explain why I so much slower.

This time the doctor I saw is one who really knows how much exercise I do as he sees me at my gym when I go for my morning mile swim. He has decided to look more into this with further blood tests which is a good step forward.

When I got back from the doctors I found this article on the Internet which would imply that red blood cells are damaged by the new prosthetic heart valve

https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.4960210604

"Mechanical trauma to red blood cells is the primary cause of hemolytic disease in patients with prosthetic heart valves"

Has anyone else noticed their performance changes post AVR?

Martin
Click to expand...
And please do not go by everything you come across on the internet. Best to talk to your cardio doctor. You seem to be happy with this one and I would advise you to talk to this doctor and ask many questions. It is your right to ask questions. It is not always best to depend on article on internet, since some might be out of date information. You must give this heart doctor a chance to answer your questions. And give him a chance to find out information for you. Good luck with getting the information from a more reliable source.
 
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