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Table of Contents
LETTER TO THE EDITOR
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 129-130

Sickle cell trait at high altitude


1 Department of Infectious Disease and Tropical Medicine, Imam Khomeini Hospital, Ardabil University of Medical Science, Ardabil, Iran
2 Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Science, Ardabil, Iran

Date of Web Publication9-Jun-2015

Correspondence Address:
Nasrollah Maleki
Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.158428

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How to cite this article:
Habibzadeh S, Maleki N. Sickle cell trait at high altitude. Int J Crit Illn Inj Sci 2015;5:129-30

How to cite this URL:
Habibzadeh S, Maleki N. Sickle cell trait at high altitude. Int J Crit Illn Inj Sci [serial online] 2015 [cited 2019 Oct 14];5:129-30. Available from: http://www.ijciis.org/text.asp?2015/5/2/129/158428

Dear Editor,

Sickle cell anemia (SCA) is one of the common hemoglobinopathies in the world. It can affect any part of the body and one of the most common and an early organ to be affected in SCA is the spleen. Massive splenic infarction which is arbitrarily defined as infarction involving more than 50% of the spleen size is a rare and unique complication of SCA. [1] In sickle cell trait, large splenic infarcts in the normal sized spleen were reported following exposure to hypoxia during high altitude flights in an unpressurized air planes or during mountain climbing. [2],[3]

Herein, we present a case of sickle cell trait associated with splenic infarction after mountain climbing. An 18-year-old male presented to our emergency department because of severe left upper quadrant pain and fever after mountain climbing. There was no history of similar pain before. In Physical examination, conjunctiva was pale and oral temperature was 38.1˚C. Para clinic tests revealed thrombocytopenia, high serum lactate dehydrogenase (LDH) level and mild elevation in aspartate aminotransferase (AST) and bilirubin. A contrast-enhanced computed tomography (CT) scans of the abdomen and pelvis were consistent with splenic infarction [Figure 1]. According to history of pain after mountain climbing and splenic infarction, SCA was the most probable diagnosis. Hemoglobin electrophoresis and gene analysis were consistent with sickle cell trait [Figure 2]. Treatment with nasal oxygen and hydration was started. Sever pain was controlled with opioid analgesics and was relieved gradually without any complication such as splenetic bleeding or rupture. Splenic infarcts had resolved gradually, without any specific treatment or surgical intervention.
Figure 1: A contrast enhanced computed tomography (CT) scan of the abdomen and pelvis was consistent with splenic infarction

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Figure 2: Hemoglobin electrophoresis was consistent with sickle cell trait

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In conclusion, physicians should consider splenic infarction in patients who develop suspicious symptoms after exposure to a high altitude environment. These patients could respond well to supportive management, and splenectomy would be avoided.

 
   References Top

1.
Al Jama AH, Al Salem AH, Al Dabbous IA. Massive splenic infarction in Saudi patients with sickle cell anemia: A unique manifestation. Am J Hematol 2002;69:205-9.  Back to cited text no. 1
    
2.
Stock AE. Splenic infarction associated with high altitude flying and sickle cell trait. Ann Intern Med 1956;44:554-6.  Back to cited text no. 2
    
3.
O′Brien RT, Pearson HA, Godley JA, Spencer RP. Splenic infarction and sickle-(cell) trait. N Engl J Med 1972;287:720.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]


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[Pubmed] | [DOI]



 

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