The clinical manifestations of sickle cell anemia in India seem to be milder than in Africa and Jamaica. Mostly homozygous sickle cell anemia patients seek treatment for vaso-occlusive crises, which have greatest incidence during the rainy season, followed by winter. It is interesting to note that both sickle cell anemia patients and carriers (heterozygotes) have iron deficiency. alpha Thalassemia is one of the major epistatic factors responsible for amelioration of the disease. Simple measures like vaccination in childhood, adequate oral intake of fluids with electrolytes during vaso-occlusive crises, and avoidance of exposure to extreme temperatures reduce the number of patients with vaso-occlusive crises. Premarital counseling and prenatal diagnosis also help reduce the number of births of homozygous children.