Predilection of hemolytic anemia-associated leg ulcers for the medial malleolus.
BACKGROUND
Ischemic ulcers are usually found above the lateral, and venous stasis ulcers at the medial malleoli. Leg ulcers occur in at least 25% of sickle cell disease (SSD) patients in clinic populations, usually in the malleolar region. The function of the large leg veins in most SSD patients is unimpaired.


METHODS
We determined leg ulcer location in 41 sickle cell anemia (SS), and 4 sickle-beta 0 thalassemic patients with longstanding chronic and/or recurrent leg ulceration, and reviewed published reports of leg ulcers in hereditary spherocytosis and thalassemias.


RESULTS
Of the 57 legs of the 45 SSD patients with only 1 ulcer, 42 (74%) were medial and 15 lateral. The difference was significant (p < 0.001). Of patients with only a single ulcer, 22 were medial and 4 lateral. Of 15 reported patients with leg ulcers related to spherocytosis or thalassemia, 20/24 (83%) ulcers were medial.


CONCLUSIONS
The medial malleoli are the most common site of leg ulceration in SSD and in other chronic hemolytic anemias. This suggests that stasis may play a role in the leg ulceration associated with chronic hemolytic anemia.
Sawhney
H
H
Division of Hematology-Oncology, Health Sciences Center at Brooklyn, State University of New York, USA.
Weedon
J
J
Gillette
P
P
Solomon
W
W
Braverman
A
A
D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000150:complications*; D000755:Anemia, Sickle Cell / Q000150:complications*; D000842:Ankle; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014689:Venous Insufficiency / Q000150:complications; D017086:beta-Thalassemia / Q000150:complications*