In sickle cell disease, which organ and finding is described by infarcts leading to fibrosis and increased infection risk?

• A. Spleen: Infarcts leading to fibrosis and increased risk of infection
• B. Kidneys: Enuresis, Hematuria, Inability to concentrate urine
• C. Penis: Microcirculatory obstruction possibly causing priapism
• D. Liver: Hepatomegaly, Scarring, Cirrhosis

Answer: (A)

Vaso-occlusive events in sickle cell disease most critically affect the spleen early in life. Repeated splenic infarcts progressively replace functioning splenic tissue with fibrotic scar, leading to autosplenectomy and functional asplenia. The spleen is essential for clearing encapsulated bacteria, so losing its function dramatically increases the risk of severe infections from organisms like Streptococcus pneumoniae. This combination—infarcts that heal into fibrosis plus a higher infection risk due to loss of splenic function—best fits the described scenario.

The other options describe plausible sickle-related problems (kidney concentrating defects from vasa recta damage, priapism from microvascular occlusion, liver involvement with enlargement and scarring) but they don’t capture the classic sequence of infarcts progressing to fibrosis in the spleen with the associated infection risk.