Blood, Vol. 94 No. 7 (October 1), 1999:
pp. 2332-2332
PHOTOGRAPH
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Renal Hemosiderosis Due to Intravascular Hemolysis. A 54-year-old
man presented with jaundice, dark urine, and a worsening anemia. The
patient has thalassemia minor and had a splenectomy 30 years ago. He
had a porcine mitral valve prosthesis placed in 1979 for rheumatic
heart disease; he subsequently had a St. Jude mitral valve prosthesis
placed in 1990 after developing endocarditis, and later that year
required a revision and a larger St. Jude prosthesis. He has had a
normal hematocrit in the past and is on chronic anticoagulation therapy
with warfarin. At the time of referral in June 1998, his hematocrit was
26%, with an mean corpuscular volume of 59. His peripheral smear is
shown in (A). His iron studies were consistent with iron-deficiency,
and his haptoglobin was low. The patient's urine iron stain showed
hemosiderin-laden renal tubular epithelial cells as well as free
hemosiderin (B and C). Interestingly, an echocardiogram showed normal
functioning of the prosthesis with no evidence for a perivalvular leak.
His anemia improved on oral iron therapy, and his hemolysis has
remained brisk. (Courtesy of Vincent E. Herrin, MD, Fellow in
Hematology/Oncology, and Joe C. Files, MD, Chief of Hematology,
Associate Chairman of Medicine, Division of Hematology, Department of
Medicine, University of Mississippi School of Medicine, University of
Mississippi Medical Center, 2500 N State St, Jackson, MS 39216.)
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