title: Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary.
abstract: 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.
authors.affiliation: Department of Haematology, College of Medicine, King Khalid University, Abha, Saudi Arabia. anwarsheikha@msn.com
authors.forename: Anwar
authors.initials: A
authors.lastname: Sheikha
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000328:Adult; D000531:Altitude; D006801:Humans; D008297:Male; D012805:Sickle Cell Trait / Q000150:complications* / Q000175:diagnosis; D013156:Splenectomy; D013159:Splenic Infarction / Q000209:etiology*