Complications commonly encountered in the older adult with SCD. One study showed that by the fifth decade, almost 50% of surviving SCD patients had documented damage in the organs above.¹¹  In this study, of the 8 organ systems, sickle chronic lung disease was most common, followed by renal failure, retinopathy, osteonecrosis, priapism, gallbladder disease, leg ulcers, and cerebrovascular disease. Frequency of these complications increase with age, but it is also clear that some complications (such as bilirubin levels and gallstones, and sickle nephropathy) are influenced by predisposing or protective genetic variants. The 8 organ system and some of the complications are represented here. (A-D) Sickle retinopathy. Fundus photographs of characteristic retinal lesions observed in sickle cell retinopathy. (A) Arteriolar occlusion with retinal infarcts. (B) Black “sunburst.” (C) Autoinfarcted “sea fan.” (D) Neovascularization in peripheral retina. (E) Cerebrovascular system. Cerebral hemorrhage (left) and atrophy of right cerebral hemisphere (right). (F) Sickle hepatopathy. Light microscopy (silver stain) showing cirrhotic nodules in liver (left) and gallbladder with gallstones (right). (G) Pelvis, avascular necrosis of hip joints. Right hip replacement (left) and early avascular necrosis of left hip (right). (H) Long bones. Infarction of femoral-tibia joint (left) and imaging of osteomyelitis in lower femur (right). (I) Cardiovascular disease. Histopathology showing left ventricular hypertrophy (LVH) of the heart (left) and light microscopy (hematoxylin-and-eosin stain) showing fibrous obliteration of pulmonary vessel with recanalization (right). (J) Sickle nephropathy. Light microscopy (hematoxylin-and-eosin stain) demonstrating large glomerulus and with mesangial hypercellularity (left) and large glomerulus showing sickled red blood cells within the capillaries of the glomerulus (right). (K) Leg ulceration. Chronic intractable ulceration of lower leg above ankle joint.