sickle cell disease (SCD)

Last reviewed 10/2021

Sickle cell disease (SCD) is a group of inherited, multisystemic conditions with episodes of acute illness and progressive organ damage. It is characterized by the occurrence of the sickle mutation (1,2).

  • mutation in the beta globin gene results in substitution of valine for glutamine at the sixth position in the beta-subunit of a Hb molecule and leads to the production of abnormal beta-globin chain. This alpha2-S2 tetramer is called sickle haemoglobin molecule (HbS) (1)
  • the disease shows an autosomal recessive inheritance (3), all SCD genotypes contain at least one sickle gene in which HbS comprises at least half of the haemoglobin present (4)
  • in sickle cell anaemia (homozygous SCD) - 80-99% of the haemoglobin is HbS, with most of the remainder being fetal haemoglobin (HbF)
The term sickle cell disease (SCD) represents all of the different genotypes which presents with the characteristic clinical syndrome as a result of the presence of haemoglobin S while the term sickle cell anaemia (commonest type of SCD) is used specifically for patients with the homozygos disease (2).

When exposed to low oxygen tensions or acidaemia non-covalent polymerisation of HbS takes place, resulting in distortion and sickling of red cells.

Distorted red cells cannot negotiate capillaries, with two effects:

  • cells are prematurely destroyed, especially in the spleen, reducing the mean life of a red cell to 10-12 days (4)
  • blood supply to tissues may be occluded, leading to infarction

Patient information leaflets from UK National Screening Committee:

Reference:

Related pages:

pathogenesis

types of sickle cell disease seen in the UK

epidemiology

high risk groups for sickle cell disease

predictive factors of severity in sickle cell disease (SCD)

clinical features

diagnosis

management

complications

prognosis

NHS screening programme for sickle cell and thalassaemia

diagram of inheritance pattern of an autosomal recessive condition e.g. Sickle Cell Disease, Thalassaemia, Cystic Fibrosis

diagram of parental carrier state combinations that give rise to the risk of a fetus with significant sickle cell disease or beta thalassaemia

pre-conceptual screening for haemoglobinopathies

NHS screening programme patient information leaflets for sickle cell disease and thalassaemia