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September 29, 1978

Sickle Cell Trait and Nonhypoxic Splenic Infarction

Author Affiliations

Howard University College of Medicine Washington, DC

JAMA. 1978;240(14):1484-1486. doi:10.1001/jama.1978.03290140026013

To the Editor.—  The report on spleen infarction in a subject with sickle cell trait by King et al (238:2173, 1977) raises several questions. It is doubtful that the spleen infarcts were "nonhypoxic." Arterial Po2 and O2 saturation values were not stated. Even if these were normal, could not the patient's bradycardia have recurred (undetected) and produced a stagnant, hypoxic environment in the spleen leading to erythrocyte sickling and tissue infarction? Splenic infarction in persons with sickle cell trait and an unrelated hematologic disorder such as hereditary spherocytosis (HS) has been reported.1 Absence of severe anemia and normal RBC morphological characteristics would not rule out HS in this patient. Was an RBC osmotic fragility study carried out?Also, quantitation of the patient's hemoglobin fractions (31% hemoglobin S and 61% hemoglobin A) indicates that the sum of hemoglobins A2 and F was 8%. This value seems too