Intravascular hemolysis in patients with new-generation prosthetic heart valves: A prospective study

Mecozzi, Gianclaudio; Milano, Aldo Domenico; Carlo, Marco De; Sorrentino, Flavia; Pratali, Stefano; Nardi, Carmela; Bortolotti, Uberto

doi:10.1067/mtc.2002.120337

Cited by 82 publications

(78 citation statements)

References 20 publications

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“…[25,26]. Interestingly, previous data published by Mecozzi et al [27] provided reliable support to the hypothesis that intravascular hemolysis may be very frequent in patients with prosthetic heart valves, as mild subclinical hemolysis could be identified in 26% of patients bearing a mechanical prosthesis and in 5% of those with a bioprosthesis.…”

Section: Hemolyzed Specimens and Intravascular Hemolysissupporting

confidence: 56%

Is the hemolysis index always suitable for monitoring phlebotomy performance?

Lippi

Mattiuzzi²,

Cadamuro

2018

LaboratoriumsMedizin

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Abstract:The new generation of clinical chemistry and coagulation analyzers is equipped with technical features allowing a systematic check of sample quality, including an assessment of the so-called HIL ("hemolysis", "icterus", "lipemia") indices. These measures enable an accurate and reproducible assessment of sample hemolysis in serum or plasma, hence the hemolysis index (H-index) is now also increasingly used for monitoring and benchmarking phlebotomy performance. Reliable evidence attests that intravascular hemolysis is not such a rare phenomenon, and its prevalence may be especially higher in geographical areas where congenital hemolytic diseases are endemic, as well as in healthcare settings where patients with acquired hemolytic disorders are more frequently visited or hospitalized. It is hence conceivable that monitoring phlebotomy performance based on the rate of hemolyzed specimens received by the laboratory may not be so straightforward, provided that specimens drawn from patients with intravascular hemolysis can be identified and excluded from the analysis. The aim of this article is to provide an overview of potential drawbacks in using the H-index alone for monitoring phlebotomy performance, and to offer potential solutions to improve its efficiency for this scope. We therefore suggest that the H-index may only be used for purposes of benchmarking phlebotomy performance when the overall number of diagnoses of hemolytic diseases or the haptoglobin values measured by the laboratories are comparable across different healthcare settings or geographic areas.

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Section: Hemolyzed Specimens and Intravascular Hemolysissupporting

confidence: 56%

Is the hemolysis index always suitable for monitoring phlebotomy performance?

Lippi

Mattiuzzi²,

Cadamuro

2018

LaboratoriumsMedizin

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“…The design allows a good imitation of the native healthy aortic valve through unrestricted adaption to the patient's anatomy, reproducing a normal valve/root complex. Further advantages of the FS include the absence of subclinical hemolysis, 69 the absence of imaging artifacts (on computed tomography [CT]/MRI), and potential strut-related obstruction of coronary ostia.…”

Section: Resultsmentioning

confidence: 99%

The Freedom SOLO bovine pericardial stentless valve

Stanger¹,

Tevaearai²,

Carrel³

2014

RRCC

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Abstract:The third-generation bovine pericardium Freedom SOLO (FS) stentless valve emerged in 2004 as a modified version of the Pericarbon Freedom stentless valve and as a very attractive alternative to stented bioprostheses. The design, choice of tissue, and anticalcification treatment fulfill most, if not all, requirements for an ideal valve substitute. The FS combines the singlesuture, subcoronary implantation technique with the latest-generation bovine pericardial tissue and novel anticalcification treatment. The design allows imitation of the native healthy valve through unrestricted adaption to the patient's anatomy, reproducing a normal valve/root complex. However, despite hemodynamic performance superior to stented valves, we are approaching a critical observation period as superior durability, freedom from structural valve deterioration, and nonstructural failure has not been proven as expected. However, optimal performance and freedom from structural valve deterioration depend on correct sizing and perfect symmetric implantation, to ensure low leaflet stress. Any malpositioning can lead to tissue fatigue over time. Furthermore, the potential for better outcomes depends on optimal patient selection and observance of the limitations for the use of stentless valves, particularly for the FS. Clearly, stentless valve implantation techniques are less reproducible and standardized, and require surgeondependent experience and skill. Regardless of whether or not stentless valve durability surpasses third-generation stented bioprostheses, they will continue to play a role in the surgical repertoire. This review intends to help practitioners avoid pitfalls, observe limitations, and improve patient selection for optimal long-term outcome with the attractive FS stentless valve.

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“…In addition, a chart review was performed for confounding variables within the observational period including thrombectomy, thrombolytic therapy, prosthetic valves, tricuspid valve regurgitation and pulmonary hypertension, blood transfusion, and infection [5][6][7][8][9][10][11][12][13][14]. In select patients, a review of related laboratory values during the study period was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Haptoglobin is also decreased in the setting of mechanical and shear-induced hemolysis including severe aortic stenosis, heart valves, thrombectomy, extracorporeal membrane oxygenation, and cardiac bypass surgery [6][7][8][9][10][11]. In some instances, non-immune, mechanical hemolysis has been initially confused for a hemolytic transfusion reaction [7].…”

Section: Introductionmentioning

confidence: 99%

Inferior Vena Cava Filters as a Potential Non-immune Cause of Low Serum Haptoglobin

Cooling¹,

Giacherio²,

Elkins³

2017

J Blood Disord Transfus

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Objective: Serum haptoglobin level is commonly used as a marker of hemolysis. We hypothesized that inferior vena cava (IVC) filters may be a potential non-immune etiology for subclinical hemolysis and low haptoglobin in some patients, after encountering a patient with an IVC filter, mild macrocytic anemia and unexplained severe haptoglobinemia. IVC filters can be associated with pressure gradients and turbulent blood flow in the presence of trapped clots and thrombus formation. Methods:Prospective study in patients undergoing IVC filter placement at our institution over a 3-month period in 2008. All patients had a haptoglobin level prior to filter placement, and then daily for a period of 3-14 days. The absolute and relative change in haptoglobin compared to pre-procedure levels was determined. Results were evaluated by t-test (paired, 2-tail). Statistics and graphics were performed with commercial software.Results: A total of 22 patients underwent IVC filter placement. Four patients were excluded due to low preprocedure haptoglobin levels. At least one post-procedure haptoglobin values was available until day 3 in 18/18 eligible patients. Nine patients were followed for a period of 1-2 weeks. Although the majority of patients had an increase in haptoglobin after IVC filter placement, 3/9 (30%) had >50% decrease in haptoglobin by day 7, including one patient with severe haptoglobinemia by day 14. Patients with decreased haptoglobin levels also had decreases in platelet count over the same period. Conclusion:These results suggest that IVC filters may be another non-immune, device-related cause of decreased haptoglobin in some patients.

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Intravascular hemolysis in patients with new-generation prosthetic heart valves: A prospective study

Cited by 82 publications

References 20 publications

Is the hemolysis index always suitable for monitoring phlebotomy performance?

Is the hemolysis index always suitable for monitoring phlebotomy performance?

The Freedom SOLO bovine pericardial stentless valve

Inferior Vena Cava Filters as a Potential Non-immune Cause of Low Serum Haptoglobin

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