Sickle cell disease changes normal, round red blood cells into cells that can be shaped like crescent moons. The name "sickle cell" comes from the crescent shape of the cells. (A sickle is a tool with a crescent-shaped blade.)
Normal red blood cells move easily through your blood vessels, taking oxygen to every part of your body. But sickled cells can get stuck and block blood vessels, which stops the oxygen from getting through. That can cause a lot of pain. It can also harm organs, muscles, and bones.
See a picture of sickle cells blocking a blood vessel.
Having sickle cell disease means a lifelong battle against the health problems it can cause, such as pain, infections, anemia, and stroke. But many people are able to have a very good quality of life by learning to manage the disease.
Sickle cell disease is inherited, which means it is passed from parent to child. To get sickle cell disease, a child has to inherit two sickle cell genes-one from each parent.
When a child inherits the gene from just one parent, that child has sickle cell trait. Having this trait means that you don't have the disease but you are a carrier and could pass the gene on to your children.
Painful events (sickle cell crises) are the most common symptom of sickle cell disease. They are periods of pain that happen when sickled cells get stuck in blood vessels and block the blood flow. These events usually cause pain in the hands, feet, belly, back, or chest. The pain may last for hours or for days.
People with sickle cell disease often have anemia, caused by a shortage of red blood cells. Anemia makes you feel weak and tired. People with sickle cell anemia may look pale or washed out. Their skin and the whites of their eyes may have a yellowish look (jaundice).
A simple blood test can show whether a person has sickle cell disease. Infants at high risk for sickle cell disease may be screened before they go home from the hospital.
Self-care and medical treatment can help you manage pain and avoid other health problems.
Early treatment includes daily antibiotics from 2 months to 5 years of age to help prevent infections. Routine childhood and adult immunizations are also important.
Managing pain is often a big part of having sickle cell disease. You can prepare for a painful event ahead of time by creating a pain management plan with your doctor. The plan should include what you can do at home to relieve pain for yourself or your child. The plan should also tell you when it is best to call a doctor or go to a hospital.
Some people need regular blood transfusions to lower the risk of stroke and treat anemia and other problems. Some people take medicine to prevent complications. In rare cases, a stem cell transplant might be an option.
Regular checkups are an important part of life with this disease. People with sickle cell disease need a good working relationship with a doctor who is an expert in treating it.
Learning about sickle cell disease:
Living with sickle cell disease:
Sickle cell disease is an inherited blood disorder, passed from parent to child. Children with sickle cell disease have two defective hemoglobin S genes, one from each parent. Various forms of sickle cell disorder occur when a person inherits one hemoglobin S gene (sickle cell gene) from one parent and one other type of defective hemoglobin gene from the other parent.
Normally, a person inherits two genes that tell the body to produce normal hemoglobin A. One gene comes from each parent. People who inherit one defective hemoglobin S gene and one normal hemoglobin A gene have sickle cell trait. These people don't have symptoms of sickle cell disease, and their bodies don't make sickled blood cells. But they can pass the defective hemoglobin S gene to their children.
Painful events (sickle cell crises) in the hands or feet, belly, back, or chest are the most common symptom of sickle cell disease. This pain may last from hours to days. Most people with sickle cell disease also get anemia.
When a child is born with sickle cell disease, it isn't possible to predict which symptoms will appear, when they will start, or how bad they will be.
Most people who have sickle cell disease have at least mild symptoms of chronic anemia, which may include:
Severe anemia may raise the chance of a person with sickle cell disease getting high blood pressure in the lungs (pulmonary hypertension). This can be deadly.
Painful sickle cell crisis symptoms are caused by blocked blood vessels in bones, organs, and other tissues. This can cause extreme pain for hours or days. These painful events can occur rarely to often. Sometimes home treatment can help the pain. And sometimes a hospital stay is needed.
Infants and young children may have episodes of extreme pain in the hands, the feet, or both (hand-foot syndrome).
Normal red blood cells have a 120-day lifespan. But people born with sickle cell disease have sickle-shaped blood cells that usually live no more than 20 days. These sickled cells can get stuck in blood vessels, blocking blood flow.
Less blood flow can damage the body's organs, muscles, and bones, sometimes leading to life-threatening conditions. Sickle cell disease may cause problems such as:
When a child is born with sickle cell disease, it's impossible to predict which problems will develop, when they will start, or how bad they will be. During the first 6 months of life, infants have a high level of fetal hemoglobin (HbF) in their blood, which protects them from red blood cell sickling. But dangerous complications of sickle cell disease may quickly develop between ages 6 months and 5 years, after levels of fetal hemoglobin decrease.
Older children and adults with sickle cell disease may have few problems. Or they may have a pattern of ongoing complications that shortens their lives. The most common and serious problems caused by sickle cell disease are anemia, pain, and organ failure. Stroke affects around 10 out of 100 children who have sickle cell disease.footnote 1
Other complications of sickle cell disease include:
A child's risk of getting sickle cell disorder occurs when he or she inherits one sickle cell gene and one other type of defective hemoglobin gene.
People who inherit one defective hemoglobin S gene and one normal hemoglobin A gene have sickle cell trait. They don't have symptoms of sickle cell disease, and their bodies don't make sickled blood cells. But they have a 1-out-of-2 (50%) chance of passing the defective hemoglobin S gene to each of their children.
People whose ancestors were from Africa, India, the Middle East, the Mediterranean (Turkey, Italy, Greece), and some Latin American countries are more likely to inherit the gene that can cause sickle cell disease.
For more information, see a picture of the risk of passing on an autosomal recessive disease such as sickle cell disease.
or other emergency services immediately if you have sickle cell disease and one or more of the following symptoms are present:
Call your doctor if you or your child has any of the following symptoms:
Make a pain management plan with your doctor that includes where and when to get treatment in case of a sickle cell emergency.
Painful events (crises) can be treated at home depending on how severe the pain is and how long you've had it. For more information, see Home Treatment.
If you or your child has sickle cell disease, your family doctor or general practitioner will refer you to a hematologist.
You may be referred to other health professionals who provide specialized treatment or counselling:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Sickle cell disease is diagnosed when initial tests show abnormal hemoglobin, with more testing if needed. A sickle cell test looks for sickle cell trait and sickle cell disease.
Doctors can diagnose sickle cell disease before a child is born (prenatally). Couples who are at risk for passing on this disease to their children may want to talk with a genetic counsellor about prenatal testing.
Prenatal tests include:
Sickle cell disease can be diagnosed at birth. Infants at high risk for sickle cell disease may be screened before they go home from the hospital. You can also ask for screening.
Soon after birth, a sample of blood is taken from the infant's heel and sent to a lab, where it is screened for the presence of sickle cell hemoglobin (hemoglobin S).
If one member of a couple has sickle cell disease or sickle cell trait, the other member should be tested before becoming pregnant. This test requires a blood sample, which is screened for the presence of hemoglobin S, hemoglobin C, or beta-thalassemia.
If one or both members of a couple carry a hemoglobin S gene or another abnormal hemoglobin gene, the couple may want to meet with a genetic counsellor before becoming pregnant to learn more about their chances of having a child with sickle cell disease. Your doctor can help you find a genetic counsellor to discuss a genetic test.
is a severe, common problem for people who have sickle cell disease. It can be detected early with an echocardiogram, a painless method of measuring blood flow.
Treatment involves getting routine tests to monitor health, managing pain events (crises), and treating related health problems as they arise.
Treatment for severe cases of sickle cell disease may include medicines. For more information, see Medications.
When parents learn that their baby has sickle cell disease, it's the beginning of a lifelong education process. Knowing as much as you can about the disease can help you control symptoms as they arise and know what to do in emergency situations. Treatment includes:
Starting at age 2 years, your child should get screened every now and then with a transcranial ultrasound. This test measures blood flow in the arteries of the head and neck. If test results show a high chance for stroke, your child may get blood transfusions to lower the risk.footnote 2
Routine tests include:
Pain is sometimes a chronic problem for people with sickle cell disease. Your doctor or a pain treatment specialist can help you develop pain management skills. These skills include distraction, guided imagery, deep breathing, relaxation, and positive self-talk.
Painful events can happen suddenly and unpredictably and can become life-threatening. Bouts of severe pain can last for hours to days and are difficult to treat. They're exhausting for caregivers as well as for the person in pain. For more information, see the topic Chronic Pain.
Severe episodes of prolonged erection of the penis (priapism) need evaluation by your doctor. Treatment may include fluids (hydration), pain medicines, treatment by a urologist, and blood transfusions.
There are also things you can do at home to manage pain. To learn more, see Home Treatment.
A series of blood transfusions is the treatment of choice to prevent strokes and treat other aspects of sickle cell disease. Stem cell transplant is a rare treatment. For more information, see Other Treatment.
People with sickle cell disease should avoid contact with anyone suspected of having fifth disease, which is caused by parvovirus. Parvovirus can cause the body to temporarily stop making blood cells, a severe life-threatening problem in someone who has sickle cell disease. Aplastic anemia can occur as a result of a shortage of red blood cells. It can come on suddenly and is life-threatening if not treated.
People with sickle cell disease and their families face ongoing stress. For help coping, see Home Treatment.
Sickle cell disease is an inherited blood disorder that is not preventable.
Home treatment for sickle cell disease includes steps to control pain and prevent complications of the disease. If you don't already have a home treatment plan, ask your doctor to help you make one. Use this plan whenever symptoms are present. Your plan may include tips for:
You can help your child cope with special needs in school by:
Children with sickle cell disease can usually exercise and play normally if they:
supplements are often a necessary part of the diet for people with sickle cell disease, particularly if you aren't eating enough folate-rich leafy vegetables (such as spinach).
Medicines that treat sickle cell disease include hydroxyurea and various pain medicines. Some of these medicines require a prescription. Others are available over the counter. Pain medicine may work best when combined with pain management skills, such as distraction; guided imagery; deep breathing; relaxation; and positive, encouraging self-talk.
Pain treatment for sickle cell disease pain varies depending on how bad the pain is and how long the pain lasts. Medicines that treat the pain include over-the-counter pain relievers (such as ibuprofen) and prescription opioids (such as codeine). Opiate pain medicines are used under careful medical supervision.
Some sickle cell complications are treated with surgery. Surgery options include:
Blood transfusions may be used for sickle cell disease. They are the treatment of choice to prevent strokes and treat other aspects of this disease. They can reduce the risk of some complications and improve symptoms of severe anemia.
Stem cell transplants can cure sickle cell disease. But they are not common.
Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238). Also available online: http://stroke.ahajournals.org/content/42/2/517.full.
Yawn BP, et al. (2014). Management of sickle cell disease: Summary of the 2014 evidence-based report by expert panel members. JAMA, 312(10): 1033-1048.
Other Works Consulted
Brawley OW, et al. (2008). National Institutes of Health consensus development conference statement: Hydroxyurea treatment for sickle cell disease. Annals of Internal Medicine, 148(12): 932-938.
Committee on Genetics, American Academy of Pediatrics (2002, reaffirmed 2006). Health supervision for children with sickle cell disease. Pediatrics, 109(3): 526-535.
Langlois S, et al. (2008). SOGC-CCMG clinical practice guideline: Carrier screening for thalassemia and hemoglobinopathies in Canada. Available online: http://www.sogc.org/guidelines/documents/gui218CPG0810.pdf.
Natarajan K, et al. (2010). Disorders of hemoglobin structure: Sickle cell anemia and related abnormalities. In K Kaushansky et al., eds., Williams Hematology, 8th ed., pp. 709-741. New York: McGraw-Hill.
National Heart, Lung, and Blood Institute, National Institutes of Health (2002). The Management of Sickle Cell Disease (NIH Publication No. 02-2117). Available online: http://www.nhlbi.nih.gov/health/prof/blood/sickle/.
U.S. Preventive Services Task Force (2007). Screening for Sickle Cell Disease in Newborns. Available online: http://www.ahrq.gov/clinic/uspstf/uspshemo.htm.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineDonald Sproule, MDCM, CCFP - Family MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family MedicineSpecialist Medical ReviewerMartin Steinberg, MD - Hematology
Current as ofOctober 9, 2017
Current as of: October 9, 2017
E. Gregory Thompson, MD - Internal Medicine
& Donald Sproule, MDCM, CCFP - Family Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Martin Steinberg, MD - Hematology
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