Mistaken identity: haemoglobinuria secondary to paravalvular leak masking as haematuria

Abstract

Haemolytic anaemia caused by a paravalvular leak presenting as progressively worsening red urine. Haemoglobinuria was easily mistaken for gross haematuria, resulting in extensive invasive urological investigation that proved to be futile. Further investigation following an emergency admission led to the realisation that intravascular haemolysis secondary to a paravalvular leakâ€"presenting 43 years following metallic valve insertionâ€"was the cause of discoloured urine and newly presenting symptomatic anaemia. This case highlights that there remains other causes of what often appears to be haematuria, and further exploration of alternative causes should be considered when no urological cause is found.

Haemolytic anaemia after mitral valve repair due to recurrent mild to moderate mitral regurgitation

“…In a similar case report, a 43-year-old patient with a mechanical valve presented with what appeared to be gross haematuria but turned out to be haemoglobinuria due to a paravalvular leak. Before the correct diagnosis was established, that patient, as well as the patient in our case, underwent extensive urological investigations 8. In the present case, the laboratory results also revealed mild renal failure, most likely secondary to iron deposits following intravascular haemolysis, which has previously been described 9.…”