Clinical Communications: Adults ACUTE SPLENIC SYNDROME IN AN AFRICAN-AMERICAN MALE WITH SICKLE CELL TRAIT ON A COMMERCIAL AIRPLANE FLIGHT Tiffany Murano, MD, FACEP,* Adam D. Fox, DO, FACS,† and Devashish Anjaria, MD, FACS† *Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey and †Department Surgery, Division of Trauma, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Reprint Address: Tiffany Murano, MD, FACEP, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, 30 Bergen Street, Newark, NJ 07103 , Abstract—Background: Patients with sickle cell trait (SCT) generally suffer few effects of sickle cell disease. Acute splenic syndrome is a rare but well-documented complication of SCT that can present in the setting of low oxygen tension that occurs with major changes in altitude, either by unpressurized air flight or ground travel such as mountain climbing. Objective: Our objective was to increase emergency physician awareness of the rare diagno- sis of altitude-induced splenic infarction in patients with SCT by presenting and reviewing recorded literature. Case Report: This is an unusual case of a man with SCT who suffered acute splenic syndrome while on a pres- surized airplane flight subsequently requiring splenectomy. Conclusions: Although it is a rare phenomenon, patients with SCT who are exposed to high altitudes can be subject to splenic syndrome. There are many patients who are unaware that they have SCT, which makes the diagnosis challenging for emergency physicians. In addition, because patients with SCT generally do not have complications related to their disease, diagnosing splenic syndrome might be delayed, potentially resulting in inadequate hydration, pain management, and other supportive treatment, which ultimately leads to worsening splenic syndrome and splenectomy. Ó 2013 Elsevier Inc. , Keywords—sickle cell trait; splenic syndrome; infarc- tion; high-altitude INTRODUCTION Sickle cell disease is a term used to describe a spectrum of autosomal recessive disorders affecting between 90,000 and 100,000 Americans (1). According to the Registry and Surveillance System for Hemoglobinopathies, sickle cell trait (SCT) is estimated to occur in approximately 1 in 12 African Americans (1). Approximately 300 million people worldwide are estimated to have the SCT, with the highest concentrations in Africa and the Mediterranean regions (2). Splenic syndrome is a term that describes signs and symptoms that occur due to sequestration of red cells in the spleen and vaso-occlusion by sickled red cells, leading to splenomegaly and tenderness. It is well documented in medical literature that SCT patients who experience major changes in altitude, either by unpressurized air flight or ground travel such as mountain climbing, are subject to splenic syndrome (3–6). In these settings, the low oxygen tension leads to red cell sickling and subsequent vaso-occlusion. However, there are few case reports of patients who developed splenic syndrome during a pressurized commercial airplane flight between locations that were essentially at sea level (7). We report the case of an African-American man with SCT who presented with acute splenic syndrome leading to splenic RECEIVED: 8 June 2012; FINAL SUBMISSION RECEIVED: 10 December 2012; ACCEPTED: 1 May 2013 e161 The Journal of Emergency Medicine, Vol. 45, No. 5, pp. e161–e165, 2013 Copyright Ó 2013 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2013.05.009