<prompt> Commonest presentation of sickle cell anemiaPriapismBone painFeverSplenomegaly  <response>: Clinical manifestations of sickle cell anemiaThe clinical manifestations of sickle cell anemia are -1. Chronic hemolysisIrreversible sickle cells have rigid, nondeformable cell membranes that lead to difficulty in negotiating the splenic sinusoids, sequestration, and rapid phagocytosis. This results in extra-vascular hemolysis.Some intravascular hemolysis may also occur because of increased mechanical fragility of severely damaged cells.2. Vasoocclnsive symptomsReversible sickle cells express higher than normal levels of adhesion molecules and are abnormally sticky that is responsible for occlusion of microcirculation especially of bones, lungs, spleen and penis.Vasoocclusive symptoms are the most common manifestations of sickle cell anemia.They commonly manifest as -Painful bone crisisHand-foot syndrome Dactylitis of bones of handsfeet.Autosplenectomy Predisposes to infection by encapsulated bacteria.Acute chest syndromeSequestration crisis Acute painful enlargement of spleen.Aplastic crisis due to infection by parvovirus - B19CNS symptoms Seizure, strokePriapism and infarction of penisLeg ulcersRememberSickle cell trait heterozygous state is almost always asymptomatic and the only significant manifestation is the renal concentrating defect presenting with isosthenuria. 