Jack Clifford added to England's injury concerns at No. 8 after departing early from Harlequins' 42-26 Aviva Premiership demolition of Sale.
Clifford took a bang to his right shoulder at the breakdown with five minutes of the first half remaining and was forced off knowing that it was an operation to the same joint in April that prevented him from joining the summer tour to Argentina.
England have already lost Billy Vunipola for the entire autumn series on account of knee surgery and the Saracen's understudy Nathan Hughes will not play for Wasps at Allianz Park on Sunday due to a dead leg.
Clifford was called into Eddie Jones' most recent training squad as a replacement for the stricken Vunipola and the Australian cannot afford to lose another option in a position lacking depth.
If the 24-year-old back row is lost to the treatment room, Harlequins will once more lament the injury curse that continues to thin their own ranks, the exit of tighthead Will Collier before the interval yet another unwelcome blow.
Just before kick off captain James Horwill was withdrawn from the starting XV after failing concussion protocols, but at least England forwards Chris Robshaw and Joe Marler were present after their injury lay-offs.
Despite all the disruption, Quins emerged easy winners at Twickenham Stoop and had the bonus point banked when Tim Visser ran in his second try in the 48th minute as a poor Sale team slumped to a 10th successive Premiership defeat on the road.
The Sharks could at least celebrate claiming their own bonus point after scoring three tries in the last half hour but it was Quins who climbed to fifth in the table, aided by a 17-point haul from the impressive Marcus Smith.
A wayward pass from Smith to Aaron Morris wasted an early chance but Quins recovered quickly to strike for the first time in the 12th minute with a try born out of a turnover claimed by Robshaw.
Sale scrambled back into a defensive line but Visser spied the opportunity, signalling to Danny Care who chipped to the touchline for the Scotland wing to gather and touch down.
It was Visser's tackle-busting run infield that propelled the 2012 Premiership champions forward in scoring their second try, forwards arriving to carry at close quarters until Marler ploughed over from short range.
A feature of Quins' game had been their harrying of Sale and the pressure was rewarded just after the first quarter had passed when Joe Marchant charged down AJ MacGinty's clearance to cross.
With Smith kicking all three conversions, Sharks were facing the prospect of heavy defeat and responded by battering a path downfield led by No. 8 Josh Strauss until the ball was fed to Mike Haley who side-stepped his way over the line to complete a brilliant finish.
Quins shrugged off the loss of Clifford and Collier and returned to the front foot, Smith shimmying and gliding into space before finding Marland Yarde who was brought down just in time by Denny Solomona.
Visser crossed for a second time in a carbon copy of his first try, Care the provider once more, but Sale hit back when replacement prop Halani Auilka rumbled over from a maul before Sam James intercepted to sprint home from long range.
The Sharks secured the bonus point through prop Ross Harrison but Quins had the final say when Smith worked a gap for Yarde to touch down.