A 72-year-old man who has recently had an aoic valve replacement now presents with pallor and fatigue. The red blood cell count is decreased, and schistocytes are repoed on examination of a peripheral blood smear. In addition, his indirect (unconjugated) bilirubin is significantly elevated. The cause of the anemia is likely

- Turbulent blood flow over mechanical hea valves can cause shearing of RBC, resulting in fragmented cells termed schistocytes. -The hemolysis can result in anemia and hyperbilirubinemia. OTHER OPTIONS: - cold agglutinin disease - Triggered by cool temperatures, hemolysis is d/t antibodies against RBC - Hereditary spherocytosis causes hemolytic anemia d/t intrinsic defect in red blood cells - Dietary deficiencies dont cause fragmented RBC.