LETTER TO THE EDITOR
Intervertebral disc calcification in a sickle cell
thalassemia patient
M. Kati
&
M. Tsironi
&
I. Meletis
&
D. Farmakis
&
A. Giakoumis
&
A. Aessopos
Received: 7 May 2006 / Accepted: 12 June 2006 / Published online: 11 July 2006
#
Springer-Verlag 2006
Dear Editor
Intervertebral disc calcification (IDC) is a rare age-related
phenomenon of variable clinical significance [3, 12], and
hemochromatosis has been often associated with IDC, due
to iron overload toxicity [1, 3, 7, 12–14]. Although
hemolytic anemias are characterized by excessive tissue
iron deposition and secondary hemosiderosis, only one case
of beta-thalassemic major patient with IDC is referred in the
literature [1], while in sickle cell syndromes, this phenom-
enon has not ever been described before. We report a sickle
cell thalassemia patient presented with typical IDC thoracic
and lumbar spine roentgenographic findings.
She was a 35-year-old Greek sickle cell thalassemic
patient, referred to the Hemoglobinopathies Outpatient
Clinic of our hospital because of intermittent rachialgia
and low back pain exacerbated by movements and provok-
ing extended motion limitation during the last 6 months.
Her past medical history included frequent painful
episodes of sickling crises until the age of 7 years when
transfusion and chelation therapy was applied. She was
transfused with two packets of red blood cells a month
(mean pretransfusion hemoglobin level of 8.9 g/dl), and
chelation desferrioxamine therapy was applied (35 mg kg
−1
day
−1
, three times a week). Painful crises were abolished
and she remained on this treatment until the age of 20, with
a mean ferritin level of 957 ng/dl. Since then, painful
sickling crises were very rare, usually without requiring
hospitalization. Splenectomy was performed at the age of
15 years due to splenomegaly and hypersplenism.
On clinical examination, she had a yellowish skin
pigmentation, but no ulcers in her lower extremities. Neuro-
logical examination was normal. Arterial blood pressure was
120/65 mmHg and the liver was palpated 3 cm below right
costal margin. A I/II systolic ejection murmur was heard over
apex and the 4th left intercostal space. Her laboratory data
showed: Hb 9.3 g/dl, reticulocytes 9%, WBC 12,000/ml,
ferritin 279 ng/dl, LDH 680 U/ml, total serum bilirubin
8.5 mg/dl (conjugated 6.2 mg/dl), and uric acid 7.2 mg/dl.
Glucose, urea, creatinine, serum calcium, phosphate, mag-
nesium, parathyroid hormone, liver tests, and tests for
thyroid function were within normal limits. Wright Coombs
test was negative. ECG was normal and chest X-ray did not
reveal significant cardiomegaly. Spine X-ray revealed
diffuse osteoporosis, depression of vertebral endplates with
displacement of the intervertebral disc into the vertebral
body (Schmorl nodes), and disc calcifications (Fig. 1a,b). No
radiological evidence of calcification was demonstrated in
peripheral joints. The patient responded well to nonsteroi-
dal antiinflammatory therapy.
The supply, anatomy, and function of the intervertebral
disc lead to a high susceptibility to degenerative process. In
the general population, IDC prevalence has been reported
as 5–6%, increasing with age and approaching 45% for
patients older than 85 years [3, 12]. Apart from being a
primary, idiopathic syndrome, several local injuries, and
systemic diseases have been reported to predispose to IDC
[3, 7, 12–14]. Diseases and clinical conditions inducing
spinal immobilization are highly associated to IDC, while
systemic diseases producing biochemical alterations (e.g.,
hyperparathyroidism, hypomagnesemia, hypophospatasia,
hypothyroidism, hypervitaminosis D, and hemochromato-
Ann Hematol (2006) 85:875–877
DOI 10.1007/s00277-006-0163-8
M. Kati
:
I. Meletis
:
D. Farmakis
:
A. Giakoumis
:
A. Aessopos
First Department of Internal Medicine, University of Athens,
Medical School, Laiko Hospital,
Athens, Greece
M. Tsironi (*)
University of Peloponnese, Nursing School,
Sparta, Greece
e-mail: gpoyl@otenet.gr