Profile of Infections in Sickle Cell Anemia (Disease or Trait): A Prospective Study from Western India

Abstract Background: Sickle cell anemia (SCA) is a major inherited hemoglobinopathy with high morbidity and mortality. Infections are a leading cause of complications, yet data in Indian adults are limited. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital in Gujarat, India, with the objective of evaluating the spectrum of infections, associated complications, and outcomes in adult patients with SCA. A total of 40 adults with confirmed SCA presenting with infection were enrolled and categorized into sickle cell disease (SCD; n = 16) and sickle cell trait (SCT; n = 24) based on hemoglobin electrophoresis. Clinical features, laboratory investigations, microbiological culture results, complications, and outcomes were systematically recorded and analyzed. Results: Fever (95%) was the most common presenting symptom. Urinary tract infections (UTIs) (35%) were the predominant infection, particularly among SCT patients, with Escherichia coli (45%) and Klebsiella spp. (20%) as leading isolates. Pneumonia (25%) was equally distributed across groups, whereas Streptococcus pneumoniae was more frequent in SCD. Malaria was observed mainly in SCT patients (12.5%). Acute kidney injury (AKI) occurred in 67.5% of cases, more commonly in SCT, followed by multiple organ dysfunction syndrome (15%) and sepsis (10%). Acute chest syndrome was restricted to SCD (7.5%). Overall mortality was 10% (three SCT, one SCD), with rapid deterioration reflected in shorter hospital stays among nonsurvivors. Conclusion: Infections, particularly Gram-negative UTIs, pose a major burden in Indian adults with SCA. Renal dysfunction and systemic complications are frequent, even in SCT, underscoring the need for early detection, timely management, and preventive strategies.