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Blood, 1 March 2008, Vol. 111, No. 5, pp. 2946. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Related Collections Blood Work Social Bookmarking                   What's this?  Previous Article  |  Table of Contents BLOOD WORK Traumatic hemolytic anemia View larger version (99K): [in this window] [in a new window]   Neil Abramson, Baptist Cancer Institute   A 62-year-old woman was referred for mild anemia. She was postmenopausal with no previous history of anemia, bleeding, or jaundice. Family history of anemia was negative. Her past history included the placement of an artificial aortic heart valve a number of years earlier. Her medications included warfarin (prothrombin time was well regulated) and a small dose of aspirin daily. She had a systolic murmur at the upper sternum with sounds typical of an implanted heart valve. There was no evidence of congestive heart failure. Her nails were normal and the spleen was not palpable. Hemoglobin was 111 g/L and mean corpuscular volume was 77 fL; the rest of the complete blood count (CBC) was normal. Reticulocytes were normal. LDH was mildly elevated and renal and hepatic laboratory tests were normal. Stool was hemoccult negative. Peripheral blood smear showed some microcytosis and an increased number of schistocytes. The white cells and platelets were normal. Other laboratory assessments showed evidence of early iron deficiency, a modest decrease in haptoglobin, and the presence of hemosiderin in the urine. The presence of microcytosis in a patient on an anticoagulant and aspirin raised the suspicion of iron deficiency from blood loss. However, the presence of lowered haptoglobin, hemosiderinuria, and schistocytosis implicated chronic hemolysis. This is an example of traumatic (valve-associated) hemolytic anemia. Because she had no evidence of cardiovascular decompensation, the only treatment needed was iron replacement.   The above image was first published in the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas images and images of case studies. For more information or to contribute to the Image Bank, visit ashimagebank.hematologylibrary.org. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Related Collections Blood Work Social Bookmarking                   What's this?

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