Relation between D-dimer test, arterial blood gases analysis and pulmonary hypertension in patients with chronic hemolytic anemia

Abstract

Background: Pulmonary hypertension is an increasingly recognized complication of chronic hereditary and acquired hemolytic anemias, including sickle cell disease (SCD), thalassemia intermedia and major, paroxysmal nocturnal hemoglobinuria,hereditary spherocytosis and stomatocytosis, microangiopathic hemolytic anemias, pyruvate kinase deficiency and possibly malaria.

Objectives: We aimed to detect the presence of PHT using Doppler Echocardiography and evaluate the relation between D-Dimer test, arterial blood gases analysis and pulmonary hypertension in patients with chronic hemolytic anemia which may contribute to early detection and therapeutic treatment that may potentially reverse this disease process.

Method: This is a prospective observational study that included twenty patients previously diagnosed as β thalassemia and SCD.The mean age of the patients was 20.5±6.5 years ranging from 13 to 31ys, 55% of the patients were males and 45% were females. 50% of the patients had beta thalathemia and 50% had sickle cell anemia. They were subjected to full history, clinical and laboratory examination in addition to Doppler echocardiography, D-Dimer test and ABG analysis.

Result: The overall prevalence of PHT (PASP≥30 mmHg) was 30% and they were of mild severity (<40mmHg), patients who develop PHT are characterized by history of pallor, higher systolic blood pressure and increasing hemolytic markers as high reticulocytic count, total bilirubin, AST and low hemoglobin level. There was significant positive correlation between PHT and D-Dimer level. Lower oxygen saturation was common in patients with PHT.

Conclusion: Echocardiography is still the non-invasive modality of choice in cardiac assessment among patients with chronic hemolytic anemia and should be performed at regular intervals. Also screening by D-Dimer test and ABG analysis may contribute to early detection and therapeutic treatment that may potentially reverse this disease process.