Anaemia after TAVI

[Taviterry]

In July I had a successful TAVI with an excellent recovery - until early September, when I experienced fatigue. At first I put this down to the very hot weather here in England. At the end of October I had useful telephone chats with two cardiology nurses, who looked at my records and wondered if I had become anaemic. Blood tests over the years had showed that I was not much above the recommended thresholds, with my haematocrit being under.

I had a full blood count on October 31 that showed that my red blood cells and haemoglobin had dipped blow the recommended thresholds, and another one on November 10 that showed sharp falls in such a very short period. My ferritin and Vitamin B12 and D levels were OK, so I'm not iron-deficient. My GP has contacted the local hospital to see what further tests might be arranged.

Googling suggests that 15 per cent of TAVI patients develop anaemia, though it's not always clear whether this is due to the new valve and/or the Clopidogrel blood thinners. Research suggests that reductions in white blood cell and red blood cell counts, haemoglobin level and haematocrit in users of Clopidogrel plus aspirin were significantly greater than those in users of aspirin alone. (I haven't been prescribed aspirin.) Which suggests that it could be Clopidogrel that's causing my problem.

Informed comments would be welcome.

[Hidden]

Hello, I'm not sure if my experience will help or muddy the waters.

FIrst thing to say is that I've not had a TAVI or been on Clopidogrel, mine is related to Mechanical Valves and another anti-coagulant (Warfarin).

I acquired Haemolytic Anaemia circa 4 years following valve surgery, in my case the mech valves damage the red blood cells early in the life cycle. My haemoglobin has been low now for 5 years, sometimes dipping under 80, but normally around the 120 mark. I take daily Folic Acid, but, have also had numerous blood transfusions.

There are many types of anaemia, and I'm not sure if a TAVI/Clopidogrel can the same effect on the blood as my valves, but, it be worth querying, to rule it out if nothing else.

Best wishes

[Taviterry in reply to Hidden]

On Sunday evening I emailed the hospital about my concerns and at 1130 this morning I had a phone call from the surgeon's PA invited me to a consultation on Wednesday. He wanted to see my recent blood tests and, astonishingly, could not gain entry to my Patient Access on-line records which show results for the past 12 years. Some GP surgeries can facilitate this, but not mine apparently. (So I wonder if he'd looked at my blood tests before my TAVI - I gather that had I been anaemic then I might have needed pre-op supplements.) The first suggestion was that I could show him on the results on my mobile when I saw him - the small screen would not make this easy. The second was could my surgery send him the latest results, which they have done - but surely at least the last three sets of results (one pre-TAVI and two post) would be desirable. I would have had no problem in giving him my Patient Access log-in details (perhaps changing my password afterwards).

[Taviterry in reply to Taviterry]

I had quite a long session with the surgeon today, and an ECG. He said that my heart was generally sound and was puzzled by my state. He wasn't impressed with my theories that the new valve and/or blood thinners could have contributed to the anaemia (though there are a few pieces of research that suggest they could) and didn't want to change my medication.

He wondered if I might have stomach problems and has referred me to a gastroenterologist I'll probably be having an endoscopy and a colonoscopy. These might find something nasty, but if they don't that will leave questions still unanswered. I'm not passing any blood.

[Taviterry]

My surgeon asked that I send him my Mean Corpuscular Volume readings (though surely he could have looked them up for himself) and for this year they were 88.6 (pre-TAVI), 87.2 and 87.1. Over the preceding ten years they're been in the 88s and 89s. The surgeon emailed: “These are at the lower range of normal and would be consistent with possible blood loss in the bowel as we discussed. So gastroenterology is definitely next stop."

Yet those are just below median in the approved range of 80-100. One website advises that "MCV is the most useful indicator to diagnose anaemia".