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The clinical, hemodynamic, and hematologic findings are described in 5 patients in whom severe intravascular destruction of erythrocytes resulted from incompetent prosthetic aortic valves. In each, an enzymatic or immunologic basis for anemia was excluded, and grossly attenuated survival of Cr 51 -labeled red cells was demonstrated. Destruction of erythrocytes was attributed to turbulent flow and shearing forces rather than to direct mechanical impact. In 1 patient, the half-life of tagged cells increased from 9.5 to 21 days after an incompetent Teflon valve was replaced with a prosthesis of the caged-ball type. The magnitude of regurgitant blood flow is an important determinant of the frequency with which a cell is subjected to trauma, and the derivation and application of a formula relating these variables is presented.