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Subperiosteal Bleeding With Acute Bone Infarcts in Children with Sickle Cell Disease

Ahmad A. Mallouh, MD
Am J Dis Child. 1987;141(12):1251. doi:10.1001/archpedi.1987.04460120013008.
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Sir.—Infarction of the long bones in patients with sickle cell disease is associated with swelling, warmth, redness, pain, and tenderness over a part or the entire shaft of the affected bone.1 Bone destruction and periosteal reaction with new bone formation are usually evident approximately two weeks after the onset of symptoms.1,2 This clinical and radiologic picture is indistinguishable from that of osteomyelitis, and it is different from the "typical" painful vaso-occlusive crises that are probably caused by infarction of bone marrow.1-5 Periosteal elevation and new bone formation is believed to due to an inflammatory reaction, edema, and exudate.2,6

Report of Cases.—Needle aspiration was performed in 12 Saudi children with homozygous sickle cell disease who presented with fever and swelling, warmth, and tenderness of the long bones (five tibiae, three femora, and four humeri); 2 to 5 mL of bloody or serosanguineous fluid was obtained


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