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- 저자 : ( Ali Atilla Aydin ) (검색결과 1 건)
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( Zeynep Tugba Guven ),( Selma Karaahmetoglu ),( Ali Atilla Aydin ),( Rukiye Kara ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Hemolytic anemia, following mitral ring annuloplasty, is a rare entity. In this case hemolysis following mitral ring annuloplasty and iron defi ciency anemia caused by duodenal diverticulum will be presented. Case report: 55 years old women admitted to our Internal Medicine Department with the complaints of weakness, fatigue and dispnea. She had history of hypertension and coronary artery disease. Her complaints had been beginning two months after the mitral annuloplasty operation. Her physical examination revealed; subicterus, paleness of conjunctuvia and 3/6 systolic murmur on mitral region. In biochemical evolution; Hemoglobin 7. 2 mg/dl, Htc 25. 4%, total bilirubin 2. 7 mg/dl, direct bilirubin 0. 8 mg/ dl, LDH 1881 U/L. There wasn`t occult blood in the stool. Both LDH1 and LDH2 were increased. Hypochromia, microcytosis and anisocytosis was detected in the peripheral blood smear and reticulocyte value was 3. 1%. Serum iron level 28 mg/dl, iron binding capacity 357 mg/dl, ferritin 21. 4 mg/dl and haptoglobin level was 7. 2 mg/dl. Direct coombs test was detected +2. findings were supporting hemolytic anemia. Ejection fraction was calculated in normal range at transthoracic echocardiography. There was an annuloplasty ring at mitral level, third degree mitral regurgitation and left atrial dilatation. TEE was supporting the same fi ndings. Gastroduodenoscopy revealed; a large and deep diverticulum in postbulbar area and in the second part of duodenum. Since the patient did not accept coronary artery angiography and the operation, she was discharged. Conclusion: We decided that intravascular hemolysis was due to mitral valve annuloplasty. After this operation, hemolytic anemia is a rare condition. Because if a patient admits after valvular operation with anemia; we should keep in mind that it can be hemolytic anemia. The patient should be examined in terms of other types of anemia like iron defi ciency anemia.
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