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[Splenic infarction at high altitude, Huaraz-Peru (3,100 masl)]
Douglas López de Guimaraes1, Julio Menacho López, Jovita Villanueva Palacios
1Jefe del Departamento de Emergencia del Hospital VIctor RAmos Guardia de Huaraz, Universidad Nacional de Ancash, Perú.
Insights
High altitude can cause splenic infarction in healthy individuals. Prompt diagnosis and hemoglobin electrophoresis are crucial for identifying sickle cell trait carriers presenting with abdominal pain at high altitudes.
Area of Science:
- Altitude Medicine
- Hematology
- Gastroenterology
Background:
- Splenic infarction is a rare condition.
- High altitude environments (>3000m) pose unique physiological challenges.
- Sickle cell trait is a genetic condition affecting hemoglobin.
Observation:
- Three cases of splenic infarction in healthy men at high altitude (Huaraz, 3100m) are presented.
- Patients experienced sudden onset of acute abdominal pain, nausea, vomiting, and abdominal distension.
- Clinical and radiological findings indicated splenic enlargement and infarction.
Findings:
- One patient was diagnosed with heterozygous sickle cell trait (Hb S: 38.5%) after presenting with splenic infarction.
- Two other patients, without a history of hemoglobinopathy, also presented with symptoms suggestive of splenic infarction at high altitude.
- Hemoglobin electrophoresis was recommended for all cases to rule out underlying sickle cell trait.
Implications:
- Clinicians should consider splenic infarction in healthy individuals experiencing acute abdominal pain at high altitudes.
- Early diagnosis and identification of sickle cell trait are critical for managing patients at high altitudes.
- This highlights the importance of screening for sickle cell trait in individuals presenting with splenic infarction in high-altitude regions.
Unlabelled:
We report three cases of splenic infarction in healthy men for the first time that amounted to high altitudes, observed in the hospital "Victor Ramos Guardia" Huaraz (3100 m). Case 1 (1995) of 55 years, born in Cuba, from Lima, caucasian suddenly presented acute abdominal pain in epigastrium, distension, nausea and vomiting, was laparotomized for acute abdomen and surgical pathology revealed thrombosis with splenic infarction splenic artery and vein. During follow-up in Lima, hemoglobin electrophoresis showed that it was heterozygous carrier of the sickle trait (Hb A: 57% Hb S: 38.5%). Case 2 (1998) of 23 years, born in Cuba, from Lima, Black said acute abdominal pain in left hypochondrium, shortness of breath and chest pain, clinical examination and radiography of the abdomen showed the spleen volume increased. Case 3 (2006) of 17 years, natural and from Lima, mestizo, who came on tour promotion, acute abdominal pain referred onset in the epigastrium and left hypochondrium, headache, increase heat, nausea and vomiting, pharyngitis was found acute and painful, and spleen increased in size by clinical and x-ray of abdomen simple stand. None had no history of hemoglobinopathy and anemia. In general, medical management was supportive and cases 2 and 3 are recommended hemoglobin electrophoresis. We conclude that we must think of splenic infarction associated with height in any healthy person who is first at high altitude (> 3000m) and having a sudden acute abdominal pain in epigastrium and / or left hypochondrium, pain and palpable spleen and radiological study compatible with image. In this case is indicated by hemoglobin electrophoresis to determine whether there is an individual heterozygous carrier of the sickle trait.
Keywords:
splenic infarction, high altitude, sickle trait, Huaraz.
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