- Malfunctioning mechanical valve, leading to excessive RBC shearing/trauma
- Pra- valvular leak
- Ventricular assist device or other mechanical circulatory support
- Accompanied by symptoms of chf/other to suggest valve not opening/closing normally
- In contrast, a normally functioning prostheses cause low level, asymptomatic hemolysis
- Sometimes findings of heart failure: rales, elevated JVP, edema
- Murmur associated with regurgitant or stenotic valve or para-valvular area
- Echo to assess for valvular or para-valvular dysfunction
- Macro or normocytic anemia, reticulocytosis, elevated LDH, elevated indirect bilirubin, low haptoglobin, bilirubinuria