How I approach PH screening. Every patient with SCD should be screened for “red-flag” signs and symptoms of PH at routine visits (when there is no acute illness present). Any red-flag sign/symptom, or the presence of certain comorbidities or disease-specific complications, should be further evaluated with a diagnostic echocardiogram. A moderately elevated TRV, or a mild elevation with other prognostic factors, should warrant further referral to a specialist. IV, intravenous; 6MWD, 6-minute walk distance.