# Back From the Past: A Case of Transjugular Intrahepatic Shunt-Induced Hemolysis?

## TL;DR

A patient with a modern TIPS stent developed hemolytic anemia, showing that this complication can still occur despite newer devices.

## Contribution

This case highlights that TIPS-induced hemolysis can occur with the Viatorr stent, not just older models.

## Key findings

- A 49-year-old patient with a Viatorr stent developed hemolytic anemia.
- TIPS-induced hemolysis should be considered in the differential diagnosis even with modern stents.
- Stent replacement can resolve hemolysis, emphasizing the need for early recognition.

## Abstract

Transjugular intrahepatic portosystemic shunt (TIPS)-induced hemolytic anemia was a known complication of the previously used bare metal wall stent, but it is rarely associated with the modern Viatorr stent. It is important to consider this diagnosis in specific patients, as replacement of the stent results in the resolution of the hemolysis. A 49-year-old female with alcoholic liver cirrhosis, classified as Child Pugh-C, and esophageal varices, who underwent emergent TIPS placement six weeks prior, presented with shortness of breath and acute anemia. All sources of active bleeding were excluded. Lab work and peripheral blood smear were consistent with hemolytic anemia. Hemolytic anemia was attributed to TIPS-induced hemolysis, and the patient was referred for a liver transplant. Unfortunately, she passed away before the transplant could be performed, most likely due to the persistent, unresolved anemia. This report highlights the importance of considering TIPS-induced hemolysis in the differential diagnosis of anemia, even in patients who have received the new Viatorr stent. Ruling out other causes is necessary. Replacement of the stent results in the resolution of the hemolysis. Early recognition is crucial for effective management.