Macrovascular Hemolysis

Traumatic hemolysis can occur in patients with artificial heart valves or severe calcific aortic stenosis. Some degree of hemolysis occurs in up to 10 percent of patients with aortic prostheses; mechanical valves are more likely to cause hemolysis than porcine valves. Mitral valve replacements cause less hemolysis because of the lower pressure gradient. Hemolysis also can occur in patients with prosthetic patches in the heart and, rarely, in patients who have undergone aortofemoral bypass. The hemolysis that occurs in this setting is generally mild and well tolerated. These patients should receive supplemental iron and folate. If the hemolysis is severe, the defective valve may have to be replaced.

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