1/5. Splenic calcifications in heterozygote sickle cell patients.A small, fibrotic, and even calcified spleen is the hallmark of homozygote sickle cell disease in adults. Such a condition is very rare in sickle-thalassemia and, to our knowledge, not previously reported in a sickle cell trait. We report two heterozygote sickle cell siblings with splenic calcifications, one sickle cell trait and one sickle-beta -thalassemia, without any history suggestive of splenic vasooclusive-infarctive crisis.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/5. Non hypoxia-related splenic infarct in a patient with sickle cell trait and infectious mononucleosis.splenic infarction in patients with sickle cell trait is usually related to hypoxic conditions, while non-hypoxia-related infarcts are extremely rare. We report on a case of a 17-year-old male patient, living at sea level, who developed a severe left upper quadrant abdominal pain during the course of a febrile episode. On physical examination he had a mildly palpable but extremely painful spleen. A spleen scan revealed 2 areas of impaired radionucleide distribution. Hepatic enzymes were moderately increased and the IgM anti-EBV antibodies positive. Hemoglobin electrophoresis revealed the presence of 42% of hemoglobin S. A probable diagnosis of splenic infarction was established in a patient with sickle cell trait, during the course of infectious mononucleosis. The patient was treated symptomatically. The conditions of splenic congestion induced by the EBV infection and the high-grade fever may have contributed to splenic sequestration and subsequent infarcts.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
3/5. Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary.BACKGROUND: The health risks associated with sickle cell trait are minimal in this sizable sector of the world's population, and many of these patients have no information about their sickle cell status. Splenic syndrome at high altitude is well known to be associated with sickle cell trait, and unless this complication is kept in mind these patients may be subjected to unnecessary surgery when they present with altitude-induced acute abdomen. methods: Four patients were admitted to the surgical ward with a similar complaint of acute severe left upper abdominal pain after arrival to the mountainous resort city of Abha, saudi arabia. All were subjected to splenectomy because of lack of suspicion regarding sickle cell status. RESULTS: Histologic examination of the spleen showed all patients had sickle cells in the red pulp. On further assessment all were found to have sickle cell trait with splenic infarction. In a similar study of 6 patients with known sickle cell disease who had comparable problems when they travelled to the colorado mountains, all made an uncomplicated recovery with conservative management. CONCLUSIONS: In ethnically vulnerable patients with splenic syndrome, sickle cell trait should be ruled out before considering splenectomy. These patients could respond well to supportive management, and splenectomy would be avoided.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
4/5. pulmonary embolism and splenic infarction in a patient with sickle cell trait.A 43 year-old black man with sickle cell trait documented by hemoglobin electrophoresis presented with severe pleuritic chest pain and hypoxemia three weeks after discharge following abdominal surgery. A pulmonary embolus was diagnosed by angiography and he was treated with heparin; the minimum arterial pO2 was 55 torr while O2 was being administered at a rate of 3 L/min. During this therapy, he developed abdominal pain. Computerized tomography suggested splenic infarction, which was documented by radionuclide liver-spleen scan and magnetic resonance imaging (MRI); the patient's spleen had been normal at exploratory laparotomy three weeks previously. No source for emboli was identified in the deep venous system by MRI. Although splenic infarction has been reported in patients with sickle cell trait at high altitude, this is the first reported case of splenic infarction secondary to the hypoxemia of pulmonary embolism in a patient with sickle cell trait. The spleen is subject to infarction in sickle cell trait because blood flow is slow through a hypoxemic and acidemic environment. The additional hypoxemia due to pulmonary embolism is presumed, in our patient, to have created a local splenic environment which permitted infarction to occur.- - - - - - - - - - ranking = 3keywords = spleen (Clic here for more details about this article) |
5/5. The sickle cell trait in relation to the training and assignment of duties in the armed forces: II. Aseptic splenic necrosis.Well-documented information gleaned from the world's literature reveals that in vivo sickling of erythrocytes and vascular occlusive lesions involving the spleen have occurred in individuals with the sickle cell trait (SCT) while flying in unpressurized airplanes or when exposed to hypoxic environments in mountains at intermediate altitudes. The clinical and anatomical manifestations of splenic infarcts are described. Individuals without the trait do not develop splenic infarcts during or following exposure to ambient hypoxia.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |