traumatic cardiogenic hemolytic anemia
Introduction
Introduction to traumatic cardiogenic hemolytic anemia Wound hemorrhage caused by abnormal surgical treatment of cardiac or macrovascular disease, abnormal hemodynamics or foreign matter rubbing, impacting red blood cells, causing mechanical damage, resulting in hemolytic anemia anemia. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: jaundice
Cause
Causes of traumatic cardiogenic hemolytic anemia
(1) Causes of the disease
Unsurgical multiple cardiac or macrovascular diseases such as Valsalva sinus rupture, aortic stenosis, traumatic arteriovenous fistula, syphilitic heart disease, bacterial endocarditis and hypertrophic cardiomyopathy can cause traumatic cardiac origin Sexual hemolysis, but often because of bone marrow compensatory function, no anemia, or anemia is very light, do not attract attention, various valve replacement, intracardiac repair may cause the disease, but the most common is related to the main Surgery of the aneurysm (especially aortic stenosis), followed by mitral valvular disease (such as insufficiency), after the surgical treatment of cardiac or macrovascular disease, the disease is more common than before, and the degree of anemia is more serious.
(two) pathogenesis
1. The shear force generated by turbulence directly damages red blood cells, which is the most important pathogenesis of this disease. When red blood cells are subjected to shear force of 3000dyn/cm2 or more, they can be broken, and the shear force generated by turbulence often exceeds this. Value, a major factor affecting turbulence is the blood flow velocity depending on the pressure gradient. The left ventricle and the aorta produce the largest pressure gradient when the left ventricle contracts. Therefore, the blood flow is most prone to turbulence here, so the aorta is involved. The disease or the operation of the valve is most prone to occur in this disease. Patients with hypertrophic cardiomyopathy can also develop this disease. The cardiac function state affects the severity of traumatic cardiogenic hemolytic anemia. Patients with mitral regurgitation, left ventricular contraction At the same time, a large pressure gradient occurs between the left atrium and the same condition occurs. Any cause such as valvular insufficiency, artificial valve tearing or a gap with the surrounding tissue may cause turbulence.
2. The injury of red blood cells by artificial valve mainly causes hemolysis from two aspects of damage to red blood cells. First, the degree of surface of artificial valve, the surface roughness is easy to rub and damage red blood cells; the surface of artificial valve made by Tefron or Dacron cloth containing rubber is often rough. The chance of hemolysis is greater; the surface of the valve made of metal is smoother, and hemolysis occurs relatively less. In addition, on the rough surface of the valve, fibrin deposition is easy to occur, which is similar to microvascular hemolysis. The material of the artificial valve is not only different in surface roughness, but also other factors affect the occurrence of hemolysis, for example, whether it is a biological valve or a mechanical valve, and whether it is easily covered by endothelial cells.
3. Hemolysis involving other immune mechanisms is a secondary factor in the occurrence of this disease. Individual patients have positive Coombs test, which may be caused by cell antigens exposed after mechanical injury, induced autoantibodies, and lesions or repairs. The posterior valve and the replaced prosthetic valve directly damage the red blood cells when closed.
Prevention
Traumatic cardiogenic hemolytic anemia prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Traumatic cardiogenic hemolytic anemia complications Complications
Can be complicated by acute hemolysis, mostly due to valve tear, leakage or cardiac output increased sharply in a short period of time, at this time there may be acute hemolysis, jaundice, macroscopic hemoglobinuria, visible in patients with heart failure Acute intravascular hemolysis can be life-threatening.
Symptom
Traumatic cardiogenic hemolytic anemia symptoms common symptoms iron deficiency anemia bacterial endocarditis proteinuria hemolytic anemia
Hemolysis is mostly chronic, persistent, and the amount of damaged red blood cells varies, depending on the lesion location, degree and type of replacement valve, quality, state and scope of surgery, cardiac output, etc., small amount of hemolysis, bone marrow hematopoietic function can be compensated No anemia occurs, except for the symptoms and signs brought about by the original heart disease or surgery, there is no other clinical manifestations. If the amount of hemolysis is large and exceeds the compensation of bone marrow hematopoietic function, there will be anemia of varying degrees without surgery. The patient often has a small amount of hemolysis, no or only mild anemia. Postoperative patients are more likely to have anemia due to more hemolysis, and the degree is heavier. Even multiple transfusions are needed, and bacterial endocarditis occurs. Other chronic inflammation can also affect bone marrow hematopoiesis, aggravating anemia, and patients rarely have macroscopic hemoglobinuria. In chronic chronic hemolysis, iron is excreted from the urine in the form of hemoglobin and hemosiderin, which may be secondary to iron deficiency anemia.
Examine
Examination of traumatic cardiogenic hemolytic anemia
1. Peripheral blood anemia varies, unless it is accompanied by iron deficiency, anemia is generally positive cell pigmentation, the emergence of many broken red blood cells is a prominent feature of the disease, the shape is like a helmet, triangle, etc., the number of broken cells can reflect The degree of hemolysis, the degree of hemolysis may not occur in such cells, spherical red blood cells can be seen in the peripheral blood, the number of white blood cells is normal or slightly high, the number of platelets can be reduced, and the reticulocytes are slightly increased.
2. Urine hemosiderin and hemoglobin can be positive, if there is acute hemolysis, there are corresponding characteristics.
3. Bone marrow-like red blood cell line hyperplasia is obviously active, and if there is iron deficiency, it may have corresponding characteristics.
According to the condition, clinical manifestations, symptoms, signs, you can choose to do ECG, B-ultrasound, X-ray, biochemical examination.
Diagnosis
Diagnosis and diagnosis of traumatic cardiogenic hemolytic anemia
According to the patient's history of heart disease, history and physical signs, combined with clinical and laboratory tests of hemolytic anemia, diagnosis is not difficult.
However, it should be noted that except for iron deficiency, bacterial endocarditis and other anemia, patients with mild hemolytic anemia, in the differential diagnosis, should consider the possibility of this disease, so as not to miss the diagnosis.
