Paraspinal extramedullary haematopoiesis in a patient with sickle cell disease: a rare clinical presentation

Background: Extramedullary haematopoiesis refers to the formation of blood cells outside the bone marrow, typically as a compensatory response to chronic anaemia or bone marrow failure. It is a well-documented phenomenon in hemoglobinopathies with ineffective erythropoiesis, such as thalassemia major and intermedia, where it occurs frequently due to persistent marrow stress. However, in sickle cell disease, extramedullary haematopoiesis is considered a rare phenomenon. This rarity is attributed to the fact that, in sickle cell disease, anaemia is primarily due to haemolysis rather than ineffective erythropoiesis. When extramedullary haematopoiesis does occur in sickle cell disease, it often involves unusual sites such as the paraspinal regions, potentially causing compressive symptoms. Recognition of this rare complication is crucial for timely diagnosis and management. Case presentation: We report a case of a 43-year-old male with homozygous sickle cell disease who presented with progressive mid back pain and bilateral lower limb weakness. Magnetic resonance imaging of the thoracic spine revealed a well-circumscribed paraspinal mass causing spinal cord compression. Discussion: Paraspinal extramedullary haematopoiesis should be considered in the differential diagnosis of spinal masses in patients with chronic haemolytic anaemias. While often asymptomatic, mass effect can lead to neurological deficits requiring urgent intervention. Diagnosis is based on imaging and requires histological confirmation. Treatment options include blood transfusion to suppress erythropoiesis, radiotherapy, and surgical decompression in severe cases. Conclusion: This case underscores the importance of recognizing paraspinal extramedullary haematopoiesis as a potential cause of neurological symptoms in sickle cell disease patients. Timely diagnosis and multidisciplinary management are essential to prevent irreversible complications.