Hyposideraemia and Haemolysis in Patients with Lillehei-Kaster or Starr-Edwards Heart Valve Prostheses

The haematological status was evaluated in 128 consecutive patients 3 to 24 months after aortic and/or mitral valve replacement with Starr-Edwards' or Lillehei-Kaster prostheses. Anaemia was present in 2%, and hyposideraemia in 20%. The incidence of compensated intravascular haemolysis was very high, subnormal serum haptoglobin being present in 80% of the patients, and serum LDH elevated in 91%. The hyposideraemia was associated with a significant decrease of haemoglobin concentration, haematocrit, mean corpuscular haemoglobin content and mean corpuscular volume, while serum transferrin concentration was elevated. These findings indicate that the hyposideraemia is caused by a true iron deficiency, which can be ascribed to the increased urinary iron loss associated with intravascular haemolysis. The degree of haemolysis appeared to be higher in patients with Starr-Edwards prostheses than in subjects with Lillehei-Raster prostheses, and was more pronounced in patients with double valves than in subjects with single valves. Oral iron therapy induced a significant rise of serum iron and haemoglobin concentrations in hyposideraemic patients. It is suggested that the follow-up of patients submitted to valvular replacement should include a measurement of serum iron concentration within the two years after operation and that iron therapy should be started in the event of hyposideraemia.