Evaluation of intravascular hemolysis with erythrocyte creatine

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Intracardiac high-velocity jets through stenosed or incompetent orifices can cause intravascular hemolysis. Intravascular hemolysis has been identified in patients with prosthetic heart valves and in patients with native valvular heart disease. Erythrocyte creatine is regarded as a sensitive and quantitative marker of mean age of the erythrocytes, because creatine contents in erythrocytes decrease gradually with advancing cell age and an increase in erythrocyte creatine quantitatively reflects the degree of shortened erythrocyte survival. To detect intravascular hemolysis in patients with cardiac valve prostheses and aortic stenosis, erythrocyte creatine was evaluated with other hemolytic markers and hemodynamic parameters.In patients with prosthetic heart valves, those with high erythrocyte creatine levels (>1.8μmol/g hemoglobin) exhibited significantly higher total peak flow velocity than those with normal erythrocyte creatine levels (p=0.006). Erythrocyte creatine had a significant correlation with total peak flow velocity (r=0.64,p<0.001). Patients with high LDH levels (>460IU/L) showed significantly higher myoglobin (p=0.008) and myosin light chain 1 (p=0.02) than those with normal LDH levels, whereas erythrocyte creatine was not related to cardiac muscle markers.In patients with aortic stenosis, patients with aortic stenosis had a significantly higher erythrocyte creatine as compared with the controls (p<0.001). Patients with aortic stenosis had significantly lower erythrocyte count, hemoglobin and hematocrit than those in controls. Fourteen of 16 patients with aortic stenosis had peak flow velocity >50mmHg and erythrocyte creatine had a good correlation with peak flow velocity (r=0.72,p<0.001).Conclusion : Erythrocyte creatine is a reliable marker to estimate the severity of intravascular hemolysis in patients with prosthetic heart valve and aortic stenosis.