Hematologic Disease and Heart Disease

Severe anemia is an important problem in patients with underlying coronary heart disease because further reduction in oxygen delivery to myocardium supplied by stenotic coronary arteries may lead to angina or myocardial infarction. Cautious transfusion may be critically important acutely in the patient with an acute coronary syndrome. Increases in fetal hemoglobin levels may reduce the frequency of sickle cell crisis spells in the adult. Congenital heart disease with right-to-left shunting is associated with the development of erythrocytosis. The need for and frequency of phlebotomy should be dictated by the patient’s symptoms or by the erythropoietin level as a measure of tissue hypoxia. Clinical problems related to primary thrombocythemia occur with platelet counts in excess of 700,000 mm3 and include both hemorrhagic and thrombotic events. Prolonged cardiopulmonary bypass is often associated with abnormalities in coagulation and hemolytic anemia. Mutations in the factor V or prothrombin gene may lead to a hypercoagulable state.