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Amoz I. Chernoff, M.D.; John B. Shapleigh, M.D.; Carl V. Moore, M.D.
JAMA. 1954;155(17):1487-1491. doi:10.1001/jama.1954.03690350029009.
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About 30 to 50% of all persons with sickle cell anemia have ulcers of the leg at some time during their lives.1 The ulcerations most commonly appear on the lower third of one or both legs, usually over the malleoli.2 Although there is frequently a history of trauma, often very minor in nature, a significant number of such lesions appear spontaneously. Characteristically the ulcers are chronic, persisting for months or even years and later recurring at the same site or in an adjacent area. They almost always are infected and possess a purulent, necrotic base, which may extend down to muscle tissue or bone. Pain is usually present and may be disabling. The pathogenesis of the ulcers associated with sickle cell anemia is not known, although it has been suggested that stasis of the abnormally shaped erythrocytes in capillaries with resultant interference with blood supply may be partly


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