 Sickle cell disease is a blood genetic disorder, usually inherited from parents and it occurs when there is a mutation on the chromosome 11 of the hemoglobin gene. The hemoglobin gene is the gene found in red blood cells. Now when this mutation happens in an individual, it is called a sickle cell treat, but then the sickle cell disease happens when you have it from both the mother and the father coming together in one child and that now causes the sickle cell disease, which you call the HBSS. So for many others it could be AAAS, that's where you hear that, but when it comes together it becomes the HBSS. Diagnosis of the sickle cell disease happens after the first year of life, usually because the maternal hemoglobin of blood cells could still be present in that child. So genotype is done classically to do a genotype test after the first year of life in any child. Is it possible to do a diagnosis even in utero? Yes, it is possible with advancing technology. It's also possible to do it very early in life, but more often within our regular findings, within this part of the world, it's usually after the first year of life. Sometimes parents may not even be aware, especially in older years where people were not aware of the genotypes, they're usually not aware until the first symptoms occur and after these symptoms and going to the hospital, there are diagnoses of sickle cells made. But in recent times people can pick it faster than it has always been. There is what we call the sickle cell crisis. It is a mixture of several clinical disorders that a child or an adolescent, as the case may be, presents with. And you either wait for these clinical symptoms or you're diagnosed by physical looks. So oftentimes you notice that that child is weak, that child looks slightly sickly. There's usually frontal boscin on the head, usually elongated fingers, that's talking about the physique of that child, the elongation of bones, and these are physical features you'll find. But then in terms of symptoms, you are looking at one of the symptoms such as the vasoclusive crisis, which is the commonest symptom. Sickle cell disease patients or sickle cell patients apparently appear with that more often than not. That's what drags them to the hospital. It comes with pain at the joint areas. These joints, such as the knee joint, the ankle joint, the shoulder, the elbow, very excruciating pain. Usually when you ask them in a scale of 0 to 10, they'll tell you it's 9 or 9.5 as the case may be. And so this is as a result of poor blood flow in those areas. So there is a high level of lactic acid accumulated within this joint and causing crystal salt accumulation, and so there's pain. The remedy for that usually is a lot of hydration. Now other symptoms could be abdominal pain. They're usually prone to Salmonellosis, which is what we call typhoid fever. They are also very prone to enlarged spleen. So you talk about spleen sequestration, which is enlargement of the spleen, because the spleen serves as a storehouse or a dumping site. So it traps all the bad red cells and so squeezes the whole blood into it. And so the patients become, that list becomes very tender and painful. One other thing you will notice amongst them is they're usually very pale. They look very pale. So sometimes you could say, are you sick? You know? You could also notice that they have a tinge of jaundice in their eyes. So they're usually ecteric, and reasons because there's a lot of breakdown of the red blood cell leading to hyperbillirubin accumulation in the body. First risk associated with the sickle cell disease is death. I mean, at every time they can easily die, either they die of excessive pain or they die of drug overdose. I've seen a sickle cell patient that was recurrently using tramadol injections on himself because not just because of the pain relief, but the feelings he gets. And so he got used to it and kept stabbing himself so death can be one of them. And this death could also be due to drug overdose or even organ failure. Because of the poor blood flow circulation to several of these organs, there could be failure in these organs. And then you can have, even wound, they could have injuries, severe chronic injuries. Like I said, the one that was stabbing himself on his tie, he came down with the chronic sore on the tie, very large, and he had to be admitted for several of the treatments. They could even come down with things like, even sores around the joints, they could come down with arthritis. So at that level, they are not able to walk properly, they become very slender, the joints become swollen and not able to bear their weight. Sometimes it becomes even very difficult to give birth normally. So vaginal births can be an issue with sickle cell crisis patients or sickle cell patients. Many other cases, they are usually always sick, re-incorrectly sick. So there's always a case of repeated hospital admissions and of course, easily infected. All right, stress, ranging from emotional stress to mental stress to physical stress. All forms of stress has to be reduced. A regular hospital visit for check-ups, so usually I tell some of them to come in, get to know their stable states, blood levels, PCV and all of that so that you can tell once there's a change in any of these things. Because of our traditional origin and culture, many will believe that sickle cell disease is a curse on people or on a certain environment or certain tribes, it's peculiar to tribes. No, it's not. It is the same in Africa, it's the same around the Caucasian environment. So it's just simply the inheritance of this mutated gene from the mother and the father. In the days of ignorance, it was improved and it was increased. All right, now that light is gradually coming, the numbers are declining. So education and information has played a vital role in the spread or in the hazard that sickle cell disease pose. Many other people think that in sickle cell disease, they don't outgrow a certain level. Okay, they don't grow up to 22 years of age and if they do, they can grow forever. Well, that's also not true. It could happen at 40 years, it could happen at 70 years of age. The point is they are not able to withstand the pressure that every regular individual can. So Nigerians generally don't know, they treat some of them as either outcast or treat them in a different way. But I'm starting to let you know that sickle cell disease in Nigeria is very real and has taken a greater part of the population, close to 20% of our general population. That makes up to 4 to 10 million Nigerians walking around with sickle cell disease. First, within our community, within our environment, what we know about is management of sickle cell disease. It's only advanced technology that they're beginning to try out treatment, which is the final level, is the bone marrow transplant. But aside that, you have management and the management ranges from regular hydration. So when this sickle cell patient keeps getting... So most times you see them with bottles of water, so regular hydration and then, of course, some blood boosters. But they have to be careful because, originally or ordinarily, they have iron overdose or overload already because there's excessive breakdown of red cells releasing iron into the blood. So you do not take iron-containing blood boosters. And then, of course, a good diet would help. So generally, these are management, of course, a regular visit. I recommend that a monthly visit to the hospital will not be bad. For all this work, just check, just see how you're doing, all right? And then, of course, a proper rest. These things will help maintain the lifespan of these sickle cell patients. And lastly, take in every form of crisis as an emergency. Sometimes they could get so used to it that, well, we know that's what's going to happen. And you probably don't know that this one is just about to take his or her life. You never can tell when the bottle will switch. So it's important that every crisis is taken as an emergency.