Mitral valve disease as a cause of anaemia in dogs
I think this may be an under-appreciated phenomenon. Since, this article appeared:
Biomed Res Int. 2016;2016:4727054
Prevalence and Prognosis of Anemia in Dogs with Degenerative Mitral Valve Disease.
Yu IB1, Huang HP1.
I’ve been more switched on to the fact that a proportion of our ‘routine’ mitral valve disease patients indeed are mildly anaemic and without obvious alternative explanation. Degree of regeneration is variable.
The authors of that paper explore the potential causes of anaemia associated with heart failure in general: including renal dysfunction and impaired erythropoietin production, overproduction of proinflammatory cytokines such as tumor necrosis factor and interleukins, an expansion in plasma volume, and downregulation of erythropoietin, such as by angiotensin-converting enzyme inhibitors.
However, now there’s this….!:
J Cardiol. 2018 Apr;71(4):414-418
Intravascular hemolysis in patients with mitral regurgitation: Evaluation by erythrocyte creatine.
Sugiura T1, Okumiya T2, Kamioka M3, Kubo T4, Hirakawa Y4, Hisahara T1, Matsumura Y1.
Erythrocyte creatine is a reliable indicator of red cell lifespan: essentially the rate of haemolysis. The authors of this second paper present a persuasive association between eccentric mitral regurgitation jets caused by flailing leaflets, haemolysis and anaemia. Specifically, it seems that the impact of eccentric regurgitation jets on the atrial wall is what directly smashes up the red cells!. Also in human patients, transfusion-requiring hemolytic anaemia has been reported in patients with residual mitral regurgitation after mitral valve repair.
Is this an unrecognised cause of low haematocrit in dogs with mitral valve disease?