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A 23-year-old man with sickle cell disease was admitted after reporting fever and chills. He had emigrated from West Africa three months earlier. His temperature was 38.2°C, and his other vital signs were normal. His spleen was not palpable. The hemoglobin level was 8.7 g per deciliter. Electrophoresis showed a single band of hemoglobin S consistent with the presence of hemoglobin SS sickle cell disease. Examination of a blood smear revealed a few sickle cells (arrowhead) and rare red cells with Plasmodium falciparum (arrow); the patient had had no history of malaria. Although hemoglobin S is considered to be protective against P. falciparum, this is not always the case.
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