Splenic infarction as a first clinical manifestation of sickle cell/beta+ thalassemia: a case report

Abstract

Background: An association between splenic infarction, high altitude, and different subtypes of sickle cell disease (SCD) has been reported in the literature, particularly sickle cell trait. However, none of these studies reported the possibility of splenic infarction as a presenting feature of sickle cell/beta+ thalassemia. Case Presentation: A 23-year-old male college student presented to the emergency department with dull pain in the left upper quadrant and without any known history of medical illness. The patient was originally from Qatif, the Eastern Province of Saudi Arabia, and was referred to the study hospital with an ultrasound report showing splenic infarction. Upon presentation to the study hospital, the patient still had mild abdominal pain and early satiety. Examination revealed tachycardia (128/minute), upper abdominal tenderness, and splenomegaly approximately 2-3 cm below the left costal margin, with thrombocytosis and high lactate dehydrogenase (LDH) levels. Hemoglobin (HGB) electrophoresis showed hemoglobin A (HbA) 19.3; HbA2 4.9; hemoglobin F 12.9 and hemoglobin S 62.9, confirming a diagnosis of sickle cell/beta+ thalassemia. The patient was started on IV hydration and therapeutic anticoagulation with enoxaparin 60 mg subcutaneously every 12 hours. The patient's symptoms improved. Therefore, the patient was discharged on life-long apixaban (5 mg PO Bid), with close follow-up at the hematology clinic. Conclusion: Splenic infarction could be manifested as an isolated feature in patients with SCD and its subtypes, such as sickle cell beta+ thalassemia. Therefore, physicians should pay careful attention to these complications and consider HGB electrophoresis as a part of the workup.