Evaluation of hemolysis occurred in patients with left ventricle support device implanted

Evaluation of Hemolysis Occurred in Patients with Left Ventricle Support Device Implanted Objective: Impaired filling or pump functions due to heart failure, structural or functional impairment of the heart is observed; It is a complex clinical syndrome characterized by fatigue, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturia, mental status changes, anorexia and abdominal pain. In the treatment of heart failure, left ventricular assist device (LVAD) implantation is widely used in patients who do not respond despite appropriate medical treatment, inotropic support, and for bridging to transplantation. Patients with LVAD implantation experience some complications in the post-implant period. Intravascular hemolysis is one of the most important complications because it causes serious morbidity and mortality. In this study; based on clinical and laboratory data in patients with LVAD implantation, we aimed to investigate the incidence and etiology of intravascular hemolysis, the importance of free hemoglobin in the diagnosis of hemolysis, and the relationship of free hemoglobin with other hemolysis parameters. Thus, we aim to obtain early diagnosis of hemolysis, to obtain laboratory findings that guide us in diagnosis, to protect patients from the complications of hemolysis and to increase survival. Materials and Methods: Left ventricular support system (HEARTWARE, LVAD) was implanted by Akdeniz University Faculty of Medicine, Department of Cardiovascular Surgery between January 2012 and August 2021, a total of 40 patients who were newly operated, hospitalized in the service, intensive care unit and came for routine polyclinic control were included in the study. The definition of hemolysis was made by evaluating high levels of LDH, total bilirubin and free hemoglobin, low levels of haptoglobin and hemoglobin. In addition, antiglobin test was performed simultaneously in all patients to eliminate the possibility of autoimmune hemolytic anemia. Demographic data, comorbidities and laboratory results were compared in patients with and without hemolysis. The correlation between hemolysis parameters and their importance in early diagnosis has been determined. Results: It was found that 20% (n=8) of 40 patients included in the study had hemolysis, and 80% (n=32) did not. Although it was observed that age and weight values were higher in patients with hemolysis than patients without hemolysis, this difference was not statistically significant (p= 0.065 and p= 0.153, respectively). It was found that the median corrected reticulocyte count of patients with hemolysis was statistically higher than those without (p <0.001). The median haptoglobin value was lower in patients with a diagnosis of hemolysis than those without hemolysis (p <0.001). The median LDH value was significantly higher in patients with hemolysis than those without (p <0.001). It was observed that the median total bilirubin value of patients with a diagnosis of hemolysis was higher than those without hemolysis (p= 0.048). It was determined that the increased corrected reticulocyte count in the patients also increased the risk of hemolysis (Odds ratio [OR]: 1.58; p= 0.044). It was observed that decreased haptoglobin value in patients positively affected the development of hemolysis (OR: 0.028; p= 0.028). It was found that as the LDH value increased in patients, the risk of developing hemolysis increased (OR: 1.045; p= 0.023). Conclusion: Intravascular hemolysis is one of the common complications in patients after LVAD implantation and can lead to severe morbidity and early mortality. It is very important to determine the risk factors for hemolysis and to determine the laboratory parameters that can be used in early diagnosis. LDH, total bilirubin, haptoglobin, free hemoglobin value and corrected reticulocyte count are among the most important parameters used in the definition of hemolysis. High free hemoglobin value; alone is not sufficient to diagnose hemolysis and must be supported by additional laboratory tests. Keywords: LVAD, hemolysis, LDH, free hemoglobin.