Sickle Cell Anemia& Hemoglobin CMISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICESTable of Contents
Hemoglobin ...................................................................1
Hemoglobin S ................................................................2
Sickle Cell Anemia
Sickle Cell Trait
Hemoglobin C ................................................................5
Hemoglobin C Disease
Hemoglobin C Trait
Sickle Cell Hemoglobin C Disease .....................7
Most Common Hemoglobin Types ............................9
Importance of Knowing Your Hemoglobin Type .....11

HEMOGLOBIN
Hemoglobin is that portion of the red blood cells which carries
oxygen to all parts of the body. The most common type ofhemoglobin is called Hemoglobin A. Sometimes there are changes
in Hemoglobin A, and other types of hemoglobin are formed.
Genes are units of hereditary material which are passed fromparents to their children. These genes, which act in pairs,
determine the physical characteristics unique to each individual.
One gene in each pair is contributed by the mother and the othergene in the pair is contributed by the father. Just as genes for eyecolor, hair color, and many other traits are inherited, so are genesfor hemoglobin. If a person inherits a Hemoglobin A gene fromeach parent (AA), that person will have normal hemoglobin.

AA = Normal Hemoglobin

This discussion is related to two of the possible changes in normal
hemoglobin: Hemoglobin S and Hemoglobin C.

1

HEMOGLOBIN S
Sickle Cell Anemia
If a person inherits a gene for Hemoglobin S from both parents(SS), that person will have sickle cell anemia. In sickle cellanemia the hemoglobin releases too much oxygen, causing thenormally round blood cells to be sickle shaped. These sickle
cells tend to die more quickly than normal red blood cells andthe body does not receive enough oxygen. This may cause theperson to be pale, short of breath and easily tired. At times, thesickle cells may become stuck in the small blood vessels and cause
pain and damage to major organs. This condition is known as“sickle cell crisis.” Other medical problems include slow growth,more frequent infections, jaundice and blood in the urine. These
symptoms and their severity differ from person to person. Sickle
cell anemia affects one out of every 400-600 black Americans.
Although it is most common in blacks, it also occurs in people ofMediterranean, Middle Eastern, East Indian, Latin American andAsian descent.

SS = Sickle Cell Anemia

Sickle Cell Trait
Sometimes a person will inherit a gene for normal Hemoglobin
A from one parent and a gene for Hemoglobin S from the otherparent. This is Hemoglobin AS, also known as sickle cell trait.
Sickle cell trait occurs in one out of every 10-12 black Americans
and usually causes no health problems. Sickle cell trait is nota mild form of sickle cell anemia. However, there is reason forconcern. When both parents have sickle cell trait (AS), theirchildren may inherit two genes for sickle hemoglobin and havesickle cell anemia.

AS = Sickle Cell Trait
2

When both parents have Sickle Cell Trait:

ASAA ASASAS

SSthe chances with each pregnancy are one in four that a child will
have normal hemoglobin (AA); two in four that a child will havesickle cell trait (AS); and one in four that child will have sickle cellanemia (SS).
3

When one parent has normal hemoglobin andthe other parent has Sickle Cell Trait:

AAAS

AA AS AA AS
the chances with each pregnancy are two in four that a child will
have normal hemoglobin (AA); two in four that a child will havesickle cell trait (AS). There is no chance that the child will havesickle cell anemia.
BOTH PARENTS MUST HAVE AT LEAST ONE GENE FORHEMOGLOBIN S TO HAVE A CHILD WITH SICKLE CELL ANEMIA.
4

HEMOGLOBIN CHemoglobin C Disease
If a person inherits a gene for Hemoglobin C from both parents(CC), that person will have Hemoglobin C disease.
This disease may produce mild to moderate anemia, jaundice,enlarged spleen and gallstones. However, some people withHemoglobin C disease do not have any of these symptoms.
Hemoglobin C disease is relatively rare and appears inapproximately one out of every 10,000 black Americans.

CC = Hemoglobin C Disease

Hemoglobin C Trait
A person who inherits a Hemoglobin A gene from one parent and aHemoglobin C gene from the other parent, will have Hemoglobin
C trait (AC). Approximately one in every 50 black Americans has
Hemoglobin C trait. This is not a disease and there are no healthproblems associated with it.

AC = Hemoglobin C Trait

5When both parents have Hemoglobin C Trait:

ACACA A ACAC C C

the chances with each pregnancy are one in four that achild will have normal hemoglobin (AA); two in four thatthe child will have Hemoglobin C trait (AC); and one infour that the child will have Hemoglobin C disease (CC).
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Sickle Cell Hemoglobin C Disease
If a person inherits a gene for Hemoglobin S from one parent anda gene for Hemoglobin C from the other parent, that person will
have sickle cell Hemoglobin C disease (SC disease).
This disease may produce symptoms similar to sickle cell anemia
or Hemoglobin C disease. Some cases may be mild and havefew symptoms while others may be more severe and have many
symptoms. While symptoms of this disease usually appear
during the first 10 years of life, they may not appear until later.
Sometimes they first appear when a woman becomes pregnant.
These women may experience a higher rate of complications
during pregnancy. SC disease is considered to be less severe thansickle cell anemia; however, damage to hip joints and the retina are
more common in persons with SC disease. Approximately one outof every 1,000 black Americans has SC disease.

SC = Sickle Cell Hemoglobin C Disease7

When one parent has Sickle Cell Trait and theother parent has Hemoglobin C Trait:

ASACA A AC

AS S Cthe chances with each pregnancy are one in four that achild will have normal hemoglobin (AA); one in fourthat child will have hemoglobin C trait (AC); and one infour that the child will have sickle cell trait (AS); and one
in four that a child will have sickle cell hemoglobin Cdisease (SC).
8Most Common
Hemoglobin TypeCondition*AA

Most common type ofhemoglobin*ASSickle cell trait

SSSickle cell anemia*ACHemoglobin C trait

CCHemoglobin C disease

SCSickle cell hemoglobin Cdisease*As you can see, if one gene in the pair is Hemoglobin A, there
will usually be no health problems associated with that condition.
9Hemoglobin Types
Symptoms			

Inheritance

None

Will always pass on a normal
hemoglobin gene to offspringNone

50% chance of passing on asickle cell gene to offspring

Varies among individuals
and may include paleness,
shortness of breath, easily
tired, pain, slowed growth,frequent infections, jaundiceand blood in the urine

Will always pass on asickle gene to offspringNone

50% chance of passing on ahemoglobin C gene to offspring

May or may not haveanemia, jaundice, enlarged
spleen or gallstones

Will always pass on a hemoglobin
C gene to offspring

May be similar to sickle cellanemia or hemoglobin Cdisease. May havecomplications during
pregnancyWill always pass on a sickle cellgene or a hemoglobin C gene tooffspring

10

IMPORTANCE OF KNOWINGYOUR HEMOGLOBIN TYPE•

Hemoglobin abnormalities are a major health problem in theUnited States.

•You will not know if you have a gene for an unusual type ofhemoglobin unless you are tested.

•If you have an unusual hemoglobin trait, it is possible for you
to pass it on to your children.

•If one parent is found to have an unusual hemoglobin trait, theother parent may wish to be tested to determine whether thecouple might have an affected child.

•If both parents have an unusual hemoglobin type, counselingwill identify their chance of having a child with abnormalhemoglobin.

•Unusual hemoglobins are not contagious and do not affectintelligence.

•As yet there is no universal cure for the conditions associatedwith unusual hemoglobin, but treatment is available.

A simple blood test can determine your hemoglobin type. Talk
with your health care provider if you have questions or want to betested.
For additional information contact:

11Missouri Department of Health and Senior Services
P.O. Box 570
Jefferson City, MO 65102-0570
800-877-6246

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12Missouri Department of Health and Senior Services
P.O. Box 570
Jefferson City, MO 65102
Phone: 800-877-6246
www.health.mo.gov
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