ArticleJACC. Case reports2025
tMCS Causing Myocardial Extramedullary Hematopoiesis Secondary to Massive Hemolysis.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In severe heart failure with hemodynamic failure, when inotropic therapies no longer suffice (INTERMACS [Interagency Registry for Mechanically Assisted Circulatory Support] 1), temporary mechanical support is used as a bridging measure until a more definitive treatment, such as a left ventricular assist device, a total artificial heart or transplantation, is performed. Due to shear stress during the passage of blood through the pump, limited hemolysis is to be expected. We describe the case of a 37-year-old patient with terminal heart failure who suffered severe hemolysis during treatment with temporary mechanical support. Examination of the cardiac apex after left ventricular assist device implantation revealed a poorly differentiated tumor. Histopathologic examination revealed underlying extramedullary hematopoiesis, triggered by severe hemolytic anemia. Following exclusion of neoplasia, the patient subsequently underwent heart transplantation. Post-transplantation, the patient was diagnosed with alpha-thalassemia and heterozygote hemoglobin E. This combination can result in mild thalassemia with chronic low-level hemolysis and mild anemia, probably severely exacerbated in the presence of high-shear stress.
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