Causes of fragmentation hemolysis include Disseminated intravascular coagulation, a consumptive process secondary to other disorders such as sepsis, malignancy, pregnancy complications, trauma or surgery Stenotic or mechanical heart valves, or prosthetic valve dysfunction (ie, perivalvular leak) Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome or related disorders such as the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), and systemic sclerosis renal crisis Rare cases of significant repetitive impact, such as foot strike hemolysis (march hemoglobinuria), karate strikes, swimming, or hand drumming Treatment addresses the underlying process.