A 5-month-old male was treated with left ventricular assist device due to cardiac failure secondary to dilated cardiomyopathy. The patient developed acute severe intravascular hemolysis with methemoglobinemia and renal failure, related to a mechanical problem due to pump cylinder misalignment. Secondary severe methemoglobinemia has not been previously described in patients undergoing ventricular assist device. Early detection of the signs and symptoms of hemolysis is crucial to prevent further complications.
GbadegesinRZhaoSCharpieJ, et al. Significance of hemolysis on extracorporeal life support after cardiac surgery in children. Pediatr Nephrol2009; 24: 589–595.
2.
RavichandranAKParkerJNovakE, et al. Hemolysis in left ventricular assist device: a retrospective analysis of outcomes. J Heart Lung Transplant2014; 33: 44–50.
3.
GraneggerMThamsenBSchloglhoferT, et al. Blood trauma potential of the HeartWare Ventricular Assist Device in pediatric patients. J Thorac Cardiovasc Surg2020; 159(4): 1519–1527.
4.
JohnRLongJWMasseyT, et al. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support. J Thorac Cardiovasc Surg2011; 141: 932–939.
5.
LevinAPSaeedOWilleyJZ, et al. Watchful waiting in continuous-flow left ventricular assist device patients with ongoing hemolysis is associated with an increased risk for cerebrovascular accident or death. Circ Heart Fail2016; 9: e002896.
6.
BottrellSBennettMAugustinS, et al. A comparison study of haemolysis production in three contemporary centrifugal pumps. Perfusion2014; 29(5): 411–416.
7.
Toledo del CastilloBSantiagoMJLopez-HerceJ. Hemolysis and methemoglobinemia in a child with membrane oxygenator on biventricular assist device. Artif Organs2017; 41(8): 785–786.
8.
RavalJSWeardenPDOrrRA, et al. Plasma exchange in a 13-year-old male with acute intravascular hemolysis and acute kidney injury after placement of a ventricular assist device. J Clin Apheresis2012; 27: 274–277.
9.
LouSMacLarenGBestD, et al. Hemolysis in pediatric patients receiving centrifugal-pump extracorporeal membrane oxygenation: prevalence, risk factors, and outcomes. Crit Care Med2014; 42(5): 1213–1220.
10.
DufourNRadjouAThuongM. Hemolysis and plasma free hemoglobin during extracorporeal membrane oxygenation support: from clinical implications to laboratory details. ASAIO J2019; 55: 239–246.
11.
MaedaKYarlagaddaVVRosenthalDN, et al. Successful use of a ventricular assist device in a neonate with hypoplastic left heart syndrome with right ventricular dysfunction. J Thorac Cardiovasc Surg2018; 156: e171–e173.
12.
HayesCShafiHMasonH, et al. Successful reduction of plasma free-hemoglobin using therapeutic plasma exchange: a case report. Transfus Apher Sci2016; 54: 253–255.
13.
ShihHMChenYCPanCF, et al. Hemolysis induced acute kidney injury following cardiac surgery: a case report and review of the literature. Hemodial Int2013; 17: 101–106.
14.
RotherRPBellLHillmenP, et al. The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: a novel mechanism of human disease. JAMA2005; 293: 1653–1662.
15.
HeymanSNRosenSFuchsS, et al. Myoglobinuric acute renal failure in the rat: a role for medullary hypoperfusion, hypoxia, and tubular obstruction. J Am Soc Nephrol1996; 7: 1066–1074.
16.
ZagerRABurkhartKMConradDS, et al. Iron, heme oxygenase, and glutathione: effects on myohemoglobinuric proximal tubular injury. Kidney Int1995; 48: 1624–1634.
17.
HoltSMooreK. Pathogenesis of renal failure in rhabdomyolysis: the role of myoglobin. Exp Nephrol2000; 8: 72–76.
18.
FaivreBMenuPLabrudeP, et al. Hemoglobin autooxidation/oxidation mechanisms and methemoglobin prevention or reduction processes in the bloodstream. Literature review and outline of autooxidation reaction. Artif Cell Blood Sub1998; 26: 17–26.