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[Severe upper abdominal pain during a long distance flight].
[alpha-thalassemia]
A
43
-
year
-old
woman
of
Ghanaian
origin
presented
with
severe
upper
abdominal
pain
starting
on
a
long
distance
flight
.
Physical
examination
revealed
tenderness
on
palpation
in
the
left
upper
abdomen
and
flank
.
There
was
no
report
of
pre-existing
conditions
or
permanent
medication
in
the
medical
history
.
Laboratory
tests
showed
signs
of
haemolytic
anemia
and
elevated
inflammatory
parameters
.
The
"
thick
blood
smear
"
was
normal
.
Ultrasonography
revealed
an
enlarged
spleen
(
14
×
5
 
cm
)
with
inhomogeneous
parenchyma
and
vast
,
diffusely
spread
hypoechoic
lesions
in
perihilar
location
,
interpreted
as
extended
splenic
infarction
.
Symptom
onset
on
a
long
distance
flight
,
haemolytic
anemia
and
extended
splenic
infarction
led
to
the
assumption
of
a
vasoocclusive
crisis
with
haemolysis
.
Moleculargenetic
tests
proved
the
presence
of
HbSC-
sickle
cell
disease
and
heterozygous
alpha-thalassemia
.
After
infusion
of
crystalloid
solution
the
patient
was
asymptomatic
further
on
.
Due
to
splenic
infarction
she
received
prophylactic
treatment
with
Cefuroxim
.
A
vaccination
against
pneumococci
,
meningococci
and
Haemophilus
influenza
B
was
recommended
.
Mild
hypoxia
and
dehydration
on
a
long
distance
flight
can
trigger
a
sickle
cell
crisis
and
may
contribute
to
late
clinical
manifestation
and
diagnosis
of
sickle
cell
disease
in
some
cases
.
Patients
suffering
from
HbSC-
sickle
cell
disease
are
at
risk
for
the
same
life-threatening
complications
as
patients
with
HbSS-
sickle
cell
disease
.
HbSC-
sickle
cell
disease
should
not
be
considered
as
a
mild
form
of
HbSS-
sickle
cell
disease
but
as
a
separate
disease
with
specific
clinical
manifestations
.
In
contrast-enhanced
ultrasonography
,
splenic
infarction
due
to
sickle
cell
crisis
may
markedly
differ
from
"
typical
"
arterial
thromboembolic
infarction
.
Diseases
Validation
Diseases presenting
"anemia"
symptom
22q11.2 deletion syndrome
alpha-thalassemia
canavan disease
child syndrome
coats disease
congenital toxoplasmosis
cowden syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dracunculiasis
erythropoietic protoporphyria
esophageal adenocarcinoma
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
omenn syndrome
scrub typhus
sneddon syndrome
typhoid
waldenström macroglobulinemia
werner syndrome
wiskott-aldrich syndrome
This symptom has already been validated