Treatment of Leg Ulcers Leg ulcers are a common manifestation of HbSS, although their prevalence varies with geographic distribution. For example, 75% of HbSS patients in Jamaica are affected, while only 8-10% of South American patients are affected. Potential factors contributing to leg ulcerations are; obstructions due to sickle cell disease, venous insufficiency, excessive vasoconstriction caused by autonomic control malfunction and bacterial infections. Furthermore, impaired endothelial function caused by reduced bioavailability of nitric oxide and chronic anemia or hypoxia are also linked. Furthermore, venographic studies indicate that the arteriovenous shunt is the main cause of ulceration rather than venous insufficiency. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953786/Treatment for leg ulcers does not differ from normal treatment. Standard treatment involves antibiotics and debridement, as well as zinc oxide dressing and leg elevation. Red blood cell transfusion is also ideal as it can speed healing. In extreme cases, a skin graft may be necessary. (13) http://emedicine.medscape.com/article/205926-treatment#aw2aab6b6c13Stroke PreventionIdentification and control of risk factors for stroke or transient ischemic attack are crucial in patients with HbSS. The AHA and ASA have established guidelines for primary stroke prevention that are recommended to be strictly followed. Standard therapy for stroke prevention includes antiplatelet drugs, hydroxyurea, and regular blood transfusions in adults, with the goal of reducing HbS to less than 30%. Blood transfusion is also currently considered the standard prevention of stroke in children with sudden death; “The Stroke Prevention in Sickle Cell Anemia (STOP) study showed that regular blood transfusions p...... focus of the article ......Clarke M. Pulmonary arterial hypertension in anemia sickle cell [Online]. United States: Medscape; 2006. [cited February 25, 2014] Available from: http://www.medscape.org/viewarticle/547201University of Maryland Medical Center. Sickle cell anemia. [Online]. Baltimore, United States; University of Maryland Medical Center; [cited February 24, 2014] Available from: http://umm.edu/health/medical/reports/articles/sickle-cell-diseaseNational Heart, Lung, and blood Institute. How is sickle cell anemia treated? [Online]. USA; NIH; [cited February 24, 2014] Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/sca/treatment.htmlUniversity of California, Los Angeles (UCLA). Stem cell gene therapy for sickle cell disease advances toward clinical trials. [Online]. United States: ScienceDaily; 2013. [cited February 25, 2014] Available from: http://www.sciencedaily.com/releases/2013/07/130701135032.htm