title: Hemolytic anemia in a patient with hypertrophic obstructive cardiomyopathy.
abstract: A 66-year-old woman was referred for further evaluation and treatment of normocytic and normochromic anemia with hemoglobin level of 8.6 g/dL. A peripheral blood smear showed fragmented erythrocytes. The patient was then referred to the department of cardiology because of systolic murmur, ECG abnormality, and red cell fragmentation. Transthoracic echocardiography revealed hypertrophic cardiomyopathy with particularly increased interventricular septal thickness of 24 mm and a hyperkinetic wall motion, resulting in marked obstruction to left ventricular outflow tract (pressure gradient of 200 mmHg). Mitral regurgitation due to systolic anterior motion of the mitral valve leaflets was also seen. The cause of anemia was thought to be mechanical intravascular hemolysis due to left ventricular outflow tract obstruction and mitral regurgitation. She was treated with atenolol and the class Ia antiarrhythmic drug cibenzoline to relieve the outflow tract obstruction, and the pressure gradient was reduced to 70 mmHg. After 3 months of treatment, her hemoglobin level had increased to 11.4 g/dL without additional treatment for anemia.
authors.affiliation: Department of Medicine and Geriatrics, Kochi Medical School, Kochi, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kubo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitaoka
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Terauchi
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Tamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Okawa
authors.forename: Naohito
authors.initials: N
authors.lastname: Yamasaki
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yabe
authors.forename: Yoshinori L
authors.initials: YL
authors.lastname: Doi
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008944:Mitral Valve Insufficiency / Q000209:etiology; D014694:Ventricular Outflow Obstruction / Q000209:etiology
chemical_list: D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; D001262:Atenolol; C032151:cifenline