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Mechanical Haemolysis — RACP Adult Medicine MCQ

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ModerateHaematologyMechanical HaemolysisRACP Adult Medicine

A 65-year-old man with a prosthetic aortic valve presents with anaemia (Hb 85 g/L) and jaundice. Blood film shows schistocytes (fragmented red cells), polychromasia, and spherocytes. LDH is elevated, haptoglobin undetectable, and DAT is negative. Platelet count is normal. What is the most likely blood film diagnosis?

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Correct answer: B — Microangiopathic haemolytic anaemia

Schistocytes (fragmented red cells) with haemolysis markers (elevated LDH, low haptoglobin) and negative DAT in a patient with a prosthetic valve is mechanical (macroangiopathic) haemolysis. MAHA encompasses multiple causes: TTP/HUS, DIC, malignant hypertension, prosthetic valves, and HELLP syndrome. In this case, the prosthetic valve is shearing red cells.

Reference: BSH – 2024 – MAHA; ICSH Schistocyte Standardisation