title: Symptomatic anaemia 17 years after double valve replacement.
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 transfusions. She successfully underwent a second mitral valve replacement. Her anaemia resolved subsequently.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. drwongmh@gmail.com
authors.forename: M H
authors.initials: MH
authors.lastname: Wong
authors.forename: K H
authors.initials: KH
authors.lastname: Chee
authors.forename: W
authors.initials: W
authors.lastname: Azman
mesh_terms: D000328:Adult; D000740:Anemia / Q000175:diagnosis* / Q000209:etiology*; D001803:Blood Transfusion; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006242:Haptoglobins / Q000096:biosynthesis; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008943:Mitral Valve / Q000601:surgery; D012156:Reticulocytes / Q000166:cytology; D013997:Time Factors
chemical_list: D006242:Haptoglobins; D006454:Hemoglobins; D007770:L-Lactate Dehydrogenase