Patients with sickle cell anemia may develop vaso-occlusive crises in their spine, especially in the lumbosacral region (60). Onset of pain is usually acute, severe, and may be accompanied by localized spine tenderness, fever, and tachycardia. Most patients will have worsening hemolytic anemia, elevated leukocyte counts, and have evidence of sickling on their smear; such patients should be treated with hydration and analgesics (60,61). Radiographs can show osteopenia, sclerosis, fractures, and cuplike depressions in the vertebral bodies (61). Patients with sickle cell disease are at risk for osteomyelitis and bony infarcts of the spine. Thalassemia intermedia or thalassemia major can lead to growth failure, osteoporosis, spinal deformities, and back pain (62).
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