Certain limitations of our study should be taken into account. First, by defining pain rate by the amount of clinical admissions, the conclusions of our study may not be extrapolated for the number of painful crises experienced at home, which have been reported to occur frequently in sickle cell patients [14] . However, previous studies have shown that pain (during a painful crises as well as chronic pain) is related to QoL in sickle cell patients [8, 10, 13] . Second, most forms of organ damage and sickle cell-related complications were only present in a relative small group of patients, which may have underpowered our study to detect an effect of specific forms of organ damage on QoL. Mild PHT, as one of the most relevant forms of organ damage that has been associated with poor prognosis, was present in 24% of all sickle cell patients and was not related to QoL.