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High Alt Med Biol. 2019 Aug 13. doi: 10.1089/ham.2018.0120. [Epub ahead of print]

Splenic Infarct on Exposure to Extreme High Altitude in Individuals with Sickle Trait: A Single-Center Experience.

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1Department of Clinical Hematology and SCT, Army Hospital (R&R), New Delhi, India.
2Department of Pediatrics and Clinical Hematology, Army Hospital (R&R), New Delhi, India.
3Department of Hematology & BMT, Sir Ganga Ram Hospital, New Delhi, India.
4General Army Medical Services, IHQ, MOD, New Delhi, India.


Background: Sickle cell trait (SCT) is a common genetic abnormality in the so-called "sickle belts" in India. Splenic infarction often brings to medical attention an underlying SCT, when appropriately looked for. The hypoxic environment of an extreme high-altitude area (HAA) is conducive for developing a splenic infarct in an SCT individual not a native of these areas. Aims: We studied retrospectively 27 cases who presented with a splenic infarction during the last 4 years. Results: Twenty-five patients (92.5%) were diagnosed to have SCT, and 85% patients had developed splenic infarct on exposure to very HAAs. Clinically, splenomegaly was seen in 33% of patients with splenic infarct at presentation. The mean hemoglobin S was 36.92% in SCT individuals. A thrombus in the splenoportal axis was demonstrated in 22.2% of cases. Splenic rupture was a rare event, seen in only 3.5% of patients. Splenectomy was not required in any of the cases. Splenic abscess was not seen, and antibiotics were not required in any of the cases. We discuss the profile and management of these patients and review the literature on splenic infarction in HAA. Conclusion: SCT is commonly overlooked cause of splenic infarction and conservative management is effective in most of the cases. Splenectomy is required only in the rarest of rare cases. The profile and management of these patients and a review of the literature on splenic infarction in HAA has been discussed.


high altitude; sickle trait; splenectomy; splenic infarct


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