title: Pentoxifylline for the treatment of hemolytic anemia in a patient who developed recurrent gastrointestinal bleeding while on continuous-flow left ventricular assist device support.
abstract: Pentoxifylline is an agent that improves red blood cell deformability (known as a hemorrheologic effect) and reduces blood viscosity. Here, we present a case of a patient with hemolytic anemia after continuous-flow left ventricular assist device (CF-LVAD) implantation that was successfully treated with pentoxifylline. Our case is a 64-year-old African American woman who was implanted with a HeartMate II device on August 6, 2010, as a bridge to transplant for end-stage heart failure. Her postoperative course was complicated by recurrent gastrointestinal bleeding and antiplatelet therapy was discontinued. On October 25, 2011, she was readmitted with anemia and hemoglobin of 6.6 mg/dl and no identifiable source of bleeding. Her lactate dehydrogenase (LDH) was 936 IU/L, indicating severe hemolysis. Due to her evidence of hemolytic anemia and her inability to tolerate antiplatelet therapy due to recurrent bleeding, she was discharged on pentoxifylline 400 mg thrice daily on October 27, 2011, with hemoglobin of 11.2 mg/dl after transfusion. After 60 days of pentoxifylline, her hemoglobin and LDH in clinic were 10.1 mg/dl and 223 IU/L, respectively. The patient was successfully bridged to transplant in June 2012. Additional analysis of pentoxifylline as a therapeutic modality to manage hemolytic anemia after CF-LVAD implantation may be warranted.
authors.affiliation: Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA. djennin1@gmail.com
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jennings
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000743:Anemia, Hemolytic / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D010431:Pentoxifylline / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D007770:L-Lactate Dehydrogenase; D010431:Pentoxifylline