Sickle cell hepatopathy in Oman: An emerging burden demanding regional action

Sickle cell hepatopathy (SCH) represents a clinically significant yet underrecognized complication of sickle cell disease (SCD). The recent study by Al-Busafi et al.[1] provides the first comprehensive analysis of SCH in Oman, reporting the prevalence of 17% among adolescents and adults with SCD. This prevalence underscores the need to acknowledge SCH as a major public health challenge in the Gulf, where SCD is highly prevalent due to unique genetic and demographic factors.[2] The study highlights younger age, male predominance, cholelithiasis, and exchange transfusion history as the key associations with SCH. These findings diverge from global trends, where hepatopathy typically presents later in life, with lower male bias and lower gallstone frequency.[3-5] Such differences may reflect the influence of the Arab-Indian haplotype, high consanguinity, and healthcare access disparities unique to the Omani population. Equally important, the absence of independent predictors in multivariate analysis emphasizes the multifactorial nature of SCH.[6] Hemolysis, iron overload, transfusion history, and infections appear to act synergistically rather than independently. This complexity mirrors global observations, where SCH is increasingly recognized as the result of interacting biological and clinical factors rather than a single dominant driver. Genetic insights from the region further support this complexity. Building on emerging evidence that specific variants modulate SCD complications, Alghubayshi et al.[7] conducted the first case–control genome-wide association study in a Saudi cohort identifying markers associated with increased risk or protection. While not liver-specific, these findings make a strong case for targeted genetic studies in Gulf SCD populations focused on hepatopathy phenotypes and biomarker-guided risk stratification. From a clinical standpoint, these findings carry clear implications. Routine liver function testing and abdominal ultrasonography should be integrated into national SCD care pathways. Early screening may facilitate timely interventions and mitigate progression to advanced liver disease. Preventive measures such as vaccination, iron chelation, and optimized transfusion protocols must be standardized to reduce hepatic complications. The regional context of this disease adds urgency to the issue. In Saudi Arabia and other Gulf states, similar patterns of hepatobiliary complications and iron overload have been reported. In this regard, the recent article by Al-Judaibi et al.,[8] which called for a dedicated hepato-hematology program for patients with SCD, provides a timely and complementary perspective. Together with the Omani data, this body of work highlights the regional need for Gulf-wide guidelines to standardize management and optimize outcomes. Finally, this work highlights the pressing need for prospective, multicenter studies in the Gulf Cooperation Council region. Larger cohorts, histological validation, and biomarker-driven approaches could refine diagnosis and allow for risk stratification. Expanding beyond Oman will ensure regional generalizability and help design cost-effective screening programs. In conclusion, Al-Busafi et al.[1] have provided valuable insights into SCH in Oman, identifying prevalence, risk factors, and demographic trends distinct from global cohorts. Their findings, alongside the contribution of Dr. Al-Judaibi and colleagues,[8] underscore the necessity of proactive screening, region-specific guidelines, and collaborative research efforts to address this emerging burden of SCD in the Gulf.