People with sickle cell disease are susceptible to infections including osteomyelitis due to:
2. Impaired complement activity
3. Presence of infarcted or necrotic bone (due to microvascular occlusion caused by increased adhesiveness of sickled erythrocytes, leukocytes and platelets)
The peculiar susceptibility of patients with sickle cell anemia to osteomyelitis caused by salmonella and gram negative enteric bacteria is due to spread of bacteria from intestine facilitated by patchy microinfarction of bowel caused by intravascular sickling. The infarcts in bone become infected either by transient bacteremia or by activation of dormant foci of salmonella in bone marrow when tissues are infected.