Erythropoietin can obviate the need for repeated heart valve replacement in high-risk patients with severe mechanical hemolytic anemia: Case reports and literature review

Background and aim of the study: Brisk hemolysis due to perivalvular leak i s usually an indication for valve re-replacement. Repeated surgery after mu ltiple previous valve operations is associated with high mortality, morbidi ty and failure rates. The present study evaluated the role of erythropoieti n (EPO) administration in deferring or obviating the need for repeated surg ery. Methods: Three patients (two men, one woman; age range 62-76 years) with tw o mechanical valves each and two to four previous heart valve operations, w ho suffered from severe mechanical hemolytic anemia, were given subcutaneou s EPO for 15-17 months. Results: A marked reduction in red blood cell consumption was achieved with a weekly EPO dose of 18,000 U in two patients, both of whom also had mild or moderate kidney malfunction. A third patient with normal renal function and extreme hemolysis showed a transient, partial response to 30,000 U of E PO per week, and eventually needed a fifth operation. Conclusion: EPO may defer or even obviate the need for repeated valve surge ry in patients with severe hemolysis due to perivalvular leak, especially t hose with inadequate EPO response, such as those with renal malfunction.