**17. Sickle cell anaemia**

In sickle cell anaemia (SCA), because of the sickle cells that develop during the disease, infarcts affect the lungs, heart, spleen, central nervous system, retina, bones and kidneys [59]. SCA is known to create a widening in the left ventricle, hypertrophy, pulmonary hypertension and heart failure. The reason for MI seen in children with SCA is not fully known. However, it has been reported that vasospasm caused by thromboxane expressed from sequestered thrombocytes could play an important role in coronary ischaemia and necrosis [60]. Varying membrane flexibility and varying viscosity in SCA patients have also been reported to be possible causes of ischaemia and infarction.

More detailed examinations should be made of SCA patients especially in conditions of acidosis, deep anaemia, kidney failure and infection. During a vaso-occlusive crisis in SCA children, when there are non-specific ST-T changes on ECG together with chest pain, cardiac enzymes should be examined and the patient should be closely monitored. In patients with suspected myocardial ischaemia, hydration and oxygenation must be provided. It is thought that nitrates could be useful [59]. Although the role of anti-thrombotic treatment is not known, it should be considered in treatment.
