Sickle cell disease (SCD) is the most common inherited hemoglobinopathy in the 
world, with the majority of cases in sub-Saharan Africa. Concomitant nutritional 
deficiencies, infections or exposure to environmental toxins exacerbate chronic 
anemia in children with SCD. The resulting relative anemia is associated with 
increased risk of strokes, poor cognitive function and impaired growth. It may 
also attenuate optimal response to hydroxyurea therapy, the only effective and 
practical treatment option for SCD in sub-Saharan Africa. This review will focus 
on the epidemiology, clinical sequelae, and treatment of relative anemia in 
children with SCD living in low and middle-income countries in sub-Saharan 
Africa. Areas covered: The causes and treatment of relative anemia in children 
with SCD in sub-Saharan Africa. The MEDLINE database was searched using medical 
subject headings (MeSH) and keywords for articles regarding relative anemia in 
children with SCD in sub-Saharan Africa. Expert commentary: Anemia due to 
nutritional deficiencies and infectious diseases such as helminthiasis and 
malaria are prevalent in sub-Saharan Africa. Their co-existence in children with 
SCD increases morbidity and mortality. Therefore, preventing, diagnosing and 
treating the underlying cause of this relative anemia will improve SCD-related 
outcomes in children in sub-Saharan Africa.