Fig. 2.

Chronic complications of sickle cell anaemia. (A) Typical ulcer of 5 years duration on the lateral aspect of the right ankle in a 19-year-old male. Upon regular conventional conservative care the ulcer appeared to have healed on two occasions, but unfortunately it broke down again after minor trauma. A skin autograft was then carried out but failed. (B) Atypical ulcer of 3 years duration in the anterior aspect of the right thigh of a 26-year-old woman. The ulcer developed following repeated intramuscular injections of pentazocine, administered as a pain-killer by a nurse and by the patient herself. When self-care of the wound by dressing became unmanageable the patient saw a specialist and subsequently travelled to India twice for skin grafting, but the procedure failed on both occasions. It is seen that the ulcer in panel B is much deeper than that shown in panel A, reflecting a different pathogenesis. Whereas the ulcer in panel A was a direct complication of sickle cell anaemia, the ulcer in panel B can be regarded as an indirect self-inflicted consequence: painful attacks prompted administration of analgesics, and the patient, who was at the time a University student, opted for self-medication in order to avoid frequent visits to the hospital, thus saving time and money. The patient is still suffering from the consequences of ill-advised inappropriate management, but this ultimately still goes back to her underlying sickle cell anaemia. A significant impact of socio-economic status on the clinical course of sickle cell anaemia has been documented in Nigeria (Okanyi & Akinyanju, 1993).