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A Rapid Virus Test Falters in People Without Symptoms, Study Finds

Mr. Bryant, of Quidel, who received an early copy of the University of Arizona study, praised the results as “very, very good,” citing the Sofia’s ability to root out “people who are infectious.”

Quidel, which is running several studies of its own, does not yet have definitive results that show the Sofia works in people without Covid-19 symptoms. But “based on the data so far, it seems to be applicable to that population,” Mr. Bryant said of his company’s results.

Other experts advised caution.

Although C.T. values do tend to increase as virus levels diminish, exceptions to this trend exist — and there is no universal “magic-number cutoff” for infectiousness, Dr. Dien Bard said.

Failing to grow the coronavirus out of a person’s sample also does not guarantee that individual is not contagious to others, said Omai Garner, the associate director of clinical microbiology in the UCLA Health System, who was not involved in the study.

Several experts noted that the University of Arizona study did not track transmission among its participants, making it impossible to draw conclusions about how, and from whom, the virus spread.

Dr. Harris said that some of the concerns about the Sofia’s accuracy could be overcome with repeat testing. Screened frequently enough with a rapid test, infected people missed by one Sofia would probably be detected with the next, especially if the levels of virus in their bodies were rising, Dr. Harris said. He and his colleagues are now gathering data on University of Arizona athletes, who are tested daily, to investigate this possibility. Quidel has also partnered with the Pac-12 and Big Ten Conferences to conduct daily tests.

People with symptoms or known exposures to the coronavirus should still get the most precise and reliable tests available — those that use P.C.R., said Susan Butler-Wu, a clinical microbiologist at the University of Southern California who was not involved in the study. More data, she added, would be needed to figure out how rapid tests fit into the larger diagnostic landscape.

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Skin Symptoms Common in COVID ‘Long-Haulers’

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

A small subset of SARS-CoV-2 patients with “COVID toes” can be categorized as COVID long-haulers, with skin symptoms sometimes enduring for more than 150 days, a new analysis revealed.

Evaluating data from an international registry of COVID-19 patients with dermatologic symptoms, researchers found that retiform purpura rashes are linked to severe COVID-19, with 100% of these patients requiring hospitalization and 82% experiencing acute respiratory distress syndrome (ARDS).

Meanwhile, pernio/chilblains rashes, dubbed “COVID toes,” are associated with milder disease and a 16% hospitalization rate. For all COVID-related skin symptoms, the average duration is 12 days.

“The skin is another organ system that we didn’t know could have long COVID” effects, said principal investigator Esther Freeman, MD, PhD, from Massachusetts General Hospital and Harvard Medical School in Boston.



Dr Esther Freeman

“The skin is really a window into how the body is working overall, so the fact that we could visually see persistent inflammation in long-hauler patients is particularly fascinating and gives us a chance to explore what’s going on,” Freeman told Medscape Medical News. “It certainly makes sense to me, knowing what we know about other organ systems, that there might be some long-lasting inflammation” in the skin as well.

The study is a result of the collaboration between the American Academy of Dermatology and the International League of Dermatological Societies, the international registry launched this past April. While the study included provider-supplied data from 990 cases spanning 39 countries, the registry now encompasses more than 1000 patients from 41 countries, Freeman noted.

Freeman presented the data at the virtual 29th European Academy of Dermatology and Venereology (EADV) Congress.

Many studies have reported dermatologic effects of COVID-19 infection, she said, but information was lacking about duration. The registry represents the largest dataset to date detailing these persistent skin symptoms and offers insight about how COVID-19 can affect many different organ systems even after patients recover from acute infection, Freeman said.

Eight different types of skin rashes were noted in the study group, of which 303 were lab-confirmed or suspected COVID-19 patients with skin symptoms. Of those, 224 total cases and 90 lab-confirmed cases included information on how long skin symptoms lasted. Lab tests for SARS-CoV-2 included PCR and serum antibody assays.

Freeman and her team defined “long haulers” as patients with dermatologic symptoms of COVID-19 lasting 60 days or longer. These “outliers” are likely more prevalent than the registry suggests, she said, since not all providers initially reporting skin symptoms in patients updated that information over time.

“It’s important to understand that the registry is probably significantly underreporting the duration of symptoms and number of long-hauler patients,” she explained. “A registry is often a glimpse into a moment in time to these patients. To combat that, we followed up by email twice with providers to ask if patients’ symptoms were still ongoing or completed.”

Results showed a wide spectrum in average duration of symptoms among lab-confirmed

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Grocery workers at greater risk for COVID without symptoms

Grocery workers are likely at greater risk of infection with the new coronavirus, a new study shows.

Not only that, but because a high percentage of them have no symptoms when they are infected, they could become sources of future spread, the researchers said.

For the study, Harvard University T.H. Chan School of Public Health scientists studied the test results of workers at a single grocery store in Boston. One in five workers (20%) tested positive for SARS-CoV-2, and three-quarters of those with the virus had no symptoms.

These essential workers could be an important reservoir of infection, the investigators said. “Once essential workers are infected with SARS-CoV-2, they may become a significant transmission source for the community they serve,” the researchers explained.

The percentage of those infected was much higher than the virus’s prevalence in the local community, which was 0.9% to 1.3% at that time. The grocery workers who had customer-facing jobs were five times more likely to test positive, the findings showed.

The study was published this week in the journal Occupational and Environmental Medicine. The grocery workers had the coronavirus tests in May as part of a mandatory testing policy in Boston.

The workers also answered questions about symptoms and exposures, and completed detailed questionnaires about their lifestyles, medical and employment histories, working patterns, role at the store, commuting to and from work, and the protective measures they were able to take against infection at work. Most also answered questionnaires focusing on anxiety and depression.

The study was small and specific to the one location, the researchers cautioned.

“This is the first study to demonstrate the significant asymptomatic infection rate, exposure risks, and associated psychological distress of grocery retail essential workers during the pandemic,” Justin Yang and colleagues said in a journal news release.

About one in four of the 99 employees who completed the mental health questions reported feeling at least mild anxiety. About half of those respondents weren’t able to consistently practice social distancing at work. Those who were able to practice social distancing tended to be less anxious, according to the report.

Eight of the employees were mildly depressed. They were less likely to practice social distancing at work and relied on shared rides or public transportation. Those who drove their own car, walked or biked were far less likely to report depression.

“Our significant mental health finding calls for action in providing comprehensive employee assistance services to help essential workers cope with the psychological distress during the COVID-19 pandemic,” the study authors said.

The researchers also recommended that employers and government officials implement routine COVID-19 employee testing, and strategies to reduce contact.

More information

The U.S. Centers for Disease Control and Prevention has tips for preventing COVID-19 in the workplace.

Copyright 2020 HealthDay. All rights reserved.

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About 20% of grocery store workers had Covid-19, and most didn’t have symptoms, study found

These workers likely became a “significant transmission source” for Covid-19 without even knowing it because most in the study were asymptomatic.

The analysis, published Thursday in the journal Occupational and Environmental Medicine, is the first to demonstrate the significant asymptomatic infection rate, exposure risks and psychological distress grocery workers have felt during the pandemic.

In the study, 20% of the 104 grocery workers tested at a store in Boston in May had positive nasal swab tests.

This was a significantly higher rate of infection than what was seen in the surrounding communities, the researchers said. Workers who dealt with customers were five times as likely to test positive for Covid-19 as colleagues in other positions.

But three out of four of those who tested positive had no symptoms.

“We were definitely surprised to see that there were that many people that were asymptomatic,” said Dr. Justin Yang, an assistant professor at Boston University School of Medicine and a researcher at Harvard School of Public Health who worked on the study. “This is definitely very alarming as it means that retail grocery store employees are exposed to customers and sort of serve as a middleman for the virus – like a super spreader almost.”
How the pandemic has changed Americans' spending and saving habits

Workers in the study had tried to take precautions. Nearly all, 91%, said they wore a face mask at work and 77% said they also wore masks outside of work. Yet only about 66% said they were able to practice social distancing consistently on the job.

This inability to social distance had an emotional, as well as a physical impact. Nearly a quarter of the people in customer service jobs said they had problems with anxiety and depression compared to 8% of workers who did not have to interact with customers. Employees who commuted to work by bike, car or by walking were less likely to experience depression than those who used public transportation, the study found.

Flying can be safer than grocery shopping, Harvard study asserts

“If you are in an environment when you’re literally in front of a customer, you can’t be more than six feet and that is really stressful for essential employees,” Yang said.

At least 108 grocery workers have died and more than 16,300 have been infected or exposed to Covid-19, the United Food and Commercial Workers International Union, or UFCW, said Thursday. The union represents 1.3 million employees.

The rates of infection among the workers in this study do seem high, Yang said. By comparison, an earlier study of Covid-19 infections among Dutch health care workers found the infection rate was about 10%.
Wisconsin faces Covid-19 crisis as coronavirus cases continue to rise, governor says

Yang said he hopes this study prompts the government and store owners to provide better guidance, routine testing and protection for grocery store workers.

There has been a national movement to designate grocery workers as first responders which would give them priority access to testing and personal protective equipment.

In an editorial for CNN in August, Marc Perrone, the President of UFCW and Democratic Vice Presidential candidate Kamala Harris argued that grocery workers should also get hazard pay.
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GW Launches Clinic To Help ‘Long Haulers’ With Persisting COVID-19 Symptoms : NPR

Patients with “Long COVID” have relied on social media groups to get through the worst of their symptoms. Doctors at the GW COVID-19 Recovery clinic hope to provide treatment and medical research to support them.

engin akyurt/Unsplash


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Maureen would have been in her last year at the Georgetown University Law Center this fall, living in an apartment on H Street and preparing to graduate — in person or virtually — this spring. Instead, she deferred this past semester and has been at home in Upstate New York for months, passing time while she waits to start classes again in January.

It’s one of the ways her life has been sidetracked for the better part of a year. Maureen counts herself among the long-haulers, people who suffer from “Long COVID,” a lingering, rotating onslaught of symptoms that has affected patients of all ages and stumped doctors worldwide.

“I’ve been really healthy up until this point,” says Maureen, who preferred not to use her last name for privacy reasons. “I ran cross country in college. I was still trying to do five to seven miles of running a day. And this has just been absolutely debilitating.”

After experiencing all the symptoms associated with the disease caused by the novel coronavirus — headaches, fatigue, a sore throat, shortness of breath, body aches — Maureen still thought it couldn’t be COVID-19. She’d been social distancing, washing her hands, and wearing a mask. And besides, she was only 24 years old. “But I had the purple fingers and toes,” she says. “Once the COVID toes presented themselves, I did end up getting myself tested.”

But the test came back negative.

She and other long-haulers who spoke to DCist say one of the biggest challenges they’ve faced has been testing. They got sick in March or April, back when the District had testing shortages and there was widespread confusion about who had access to them. When these long-haulers were finally tested, they received false negative results — or, at least, it would appear that way since they still had symptoms.

A COVID-19 testing site in Fort Totten. Long-haulers say one of the biggest issues they’ve faced is getting accurate and timely test results.

Patrick Fort/DCist/WAMU


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Patrick Fort/DCist/WAMU

Despite her negative results, doctors told Maureen: “You definitely have COVID — just ride it out for 30 days,” she says. “But I’m still riding it out.”

The specialists she saw, including a pulmonologist, cardiologist, rheumatologist, and hematologist, weren’t able to provide many answers about what her specific condition was and how to treat it. Maureen says one told her, somewhat dismissively, “You know, anxiety manifests itself in the body.”

Her condition has become the subject of peer-reviewed studies and massive online support groups — some have even begun lobbying Congress about Long COVID.

Maureen turned her attention to friends in New York and found informative articles online, including a June feature published in The Atlantic, which made the

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Having more than 5 coronavirus symptoms may predict long-COVID case

  • Patients who experience more than five COVID-19 symptoms during their first week of illness are more likely to have a long-term case, according to a new study.
  • Certain symptoms in particular — fatigue, headache, difficulty breathing, a hoarse voice, and muscle or body aches — were also found to be early signs that a patient might not recover quickly.
  • Age, gender, and BMI could play a role as well, according to the study.
  • Visit Business Insider’s homepage for more stories.

For a select group of coronavirus patients known as “long-haulers,” the onset of symptoms is the beginning of an extended battle. Many COVID-19 patients develop weeks- or months-long illnesses that researchers now call “long-COVID.”  

These individuals are difficult to study, since not all received a proper diagnosis initially due to testing shortages or the abnormal nature of their symptoms. Some may simply not report lingering ailments, making them difficult for researchers to track.

But a spate of preliminary studies are beginning to pinpoint the early signs that a patient won’t recover right away.

A recent study from King’s College London, which is still awaiting peer review, examined more than 4,000 coronavirus patients across Sweden, the UK, and the US by asking them to record their symptoms in an app. About 20% said they still weren’t feeling better after four weeks — the threshold at which the researchers mark a case of long-COVID. By eight weeks, around 190 patients reported lingering symptoms. And by 12 weeks, nearly 100 patients said they hadn’t recovered yet.

Patients who experienced more than five symptoms during the first week of their illness were significantly more likely to develop long-COVID, the study found. That was true across sex and age groups.

The researchers also identified five symptoms that predicted a case of long-COVID more than others: fatigue, headache, difficulty breathing, a hoarse voice, and muscle or body aches. This could offer clues about targets for future COVID-19 treatments.

“It’s important we use the knowledge we have gained from the first wave in the pandemic to reduce the long-term impact of the second,” Dr. Claire Steves, the study’s senior author, said in a statement. “Thanks to the diligent logging of our contributors so far, this research could already pave the way for preventative and treatment strategies for long-COVID.”

Nearly 98% of patients with long-COVID in the study reported fatigue, while 91% reported a headache.  

“We know that fatigue is a huge component, so I’m really glad that their research captured that,” Natalie Lambert, an associate professor of medicine at Indiana University who wasn’t involved in the study, told Business Insider.

Lambert is also looking at patterns of symptoms among long-COVID patients. All of the roughly 1,500 long-haulers she surveyed in July said they’d experienced fatigue at some point in their illness. Roughly two-thirds said they had experienced muscle or body aches. The same amount said they had difficulty breathing, and around 58% said they had developed a headache.

The results of the King’s College study, Lambert said,

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Doctors Say You Should Get Screened for Colon Cancer Starting at 45, Even Without Symptoms

Photo credit: peterschreiber.media - Getty Images
Photo credit: peterschreiber.media – Getty Images

From Prevention

  • Colorectal cancer screening should start at age 45, according to new draft guidelines from the U.S. Preventive Services Task Force.

  • Current recommendations suggest that people start screening for colorectal cancer at age 50, continuing until they’re 75.

  • Doctors explain why the recommended age has been bumped up, and what colorectal cancer screening entails.

People should be screened for colorectal cancer starting at age 45, according to new draft guidelines from the U.S. Preventive Services Task Force (PSTF).

The guidelines were issued Tuesday and are not official yet. “Overall, people ages 45 to 75 should be screened to reduce their risk of dying from this disease,” a bulletin on the draft guidelines states. Current recommendations suggest that people start screening for colorectal cancer at age 50, continuing until they’re 75.

The PSTF stresses in its bulletin that the draft recommendations apply to “adults without symptoms and who do not have a personal history of colorectal polyps, or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.”

Colorectal cancer is the third leading cause of cancer deaths in the U.S. According to American Cancer Society (ACS) estimates, there will be 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer diagnosed this year. Colorectal cancer doesn’t always cause symptoms right away, but as it progresses, it can lead to a change in bowel habits, rectal bleeding, blood in the stool, abdominal pain, and unintended weight loss.

“Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people ages 50 to 75 have never been screened,” the PSTF says.

“I believe the new draft guidelines are justified and an important step in diagnosing and preventing colorectal cancer in younger patients,” says Joshua Meyer, M.D., vice chair of translational research in the Department of Radiation Oncology at Fox Chase Cancer Center. “A lot needs to change in terms of mindset around screening at a younger age.”

Why was the recommended age for colorectal cancer screening bumped up?

Photo credit: peterschreiber.media - Getty Images
Photo credit: peterschreiber.media – Getty Images

While the rate at which people are diagnosed with colorectal cancer is dropping in those who are 65 and older, it’s actually increasing in younger people. According to data from the ACS, an estimated 12% of colorectal cancer cases—about 18,000—will be diagnosed in people under the age of 50.

This has been happening for a while. Colon cancer rates in adults under 50 have been rising since the mid-80s, with younger age groups seeing the steepest increases.

Younger people are also being diagnosed at later stages. A 2017 study published in the Journal of the National Cancer Institute found that people under the age of 55 are 58% more likely to be diagnosed with late-stage colorectal cancer than older people. Why? The authors wrote that it’s “largely due to delayed follow-up of symptoms, sometimes for years, because cancer is typically not on the radar of young adults

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Rash around eyes: Causes, symptoms, and treatment

A rash can develop around the eyes for different reasons, including dermatological conditions and infections. Examples include atopic dermatitis, psoriasis, and cellulitis.

Doctors may find it difficult to diagnose skin problems around the eyes because many conditions may cause a rash. To diagnose a rash around the eyes, doctors require a detailed examination of the affected area and complete medical history.

Keep reading to learn more about the causes, symptoms, and treatment of a rash around the eyes.

Eczema is a chronic skin condition. Doctors have identified several different types of eczema, one example being atopic dermatitis (AD).

AD is a skin condition that usually appears in childhood and can develop on any area of the body, including the face and around the eyes.

The American Academy of Dermatology (AAD) state that researchers have identified the following factors that may play a role in causing AD:

People with AD may have an itchy rash. The AAD state that typically a person may first experience itchy skin. When a person scratches, a rash begins to appear.

The appearance of AD can vary depending on how old the person is:

In babies

In infants, the rash typically appears on the cheeks, scalp, and face. The skin may become dry or scaly. Sometimes, the rash may form blisters and then ooze and weep fluid.

In children

Children may develop AD in the elbow and feet creases. Other locations include:

  • neck
  • wrists
  • ankles
  • crease between buttocks and legs

Some accompanying symptoms in children may include:

  • bumpy-looking skin
  • darkened or lightened skin around the area of the rash
  • thickened or leathery skin

In adults

Approximately 2–3% of adults experience AD.

If it persists into adulthood, people may have fewer rashes. However, they tend to have:

  • extremely dry skin
  • skin that is easily irritated
  • hand eczema
  • eczema on the eyelids
  • cataracts

Adults with AD around the eyes may have darker, thickened skin circling the eyes, which may be very itchy.

Treatment

A person can make changes to their skin care routine and use certain medications to help treat AD.

Learn more about the treatment options for AD here.

Contact dermatitis is another type of eczema. There are two types of contact dermatitis:

Allergic contact dermatitis

Allergic contact dermatitis occurs when a person comes into contact with an allergen, such as:

  • nickel
  • latex
  • poison ivy
  • makeup

Symptoms include:

Irritant contact dermatitis

Irritant contact dermatitis occurs when a person comes into contact with something that damages the skin, such as:

Symptoms of irritant contact dermatitis include dry and chapped skin. If the exposure to the irritant continues, a person may notice inflamed, scaly, and swollen patches of skin.

Treatment

Treatment for either type of contact dermatitis may include antihistamines, moisturizers, and topical corticosteroid creams.

According to the British Association of Dermatologists, seborrheic means that the rash affects greasy skin zones. Seborrheic blepharitis affects the eyelids.

Seborrheic blepharitis typically occurs due to an overgrowth called Malassezia, which is a type of harmless yeast. It can also occur due

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When to take a child to the hospital for flu: Serious symptoms

Children with influenza, known as the flu, usually get better at home. However, when their symptoms are severe or last a long time, a child may need to go to the hospital for treatment.

Certain signs and symptoms indicate that medical treatment is necessary to avoid complications. Parents and caregivers should be aware of these so that they know to take prompt action when necessary.

In this article, we list the flu symptoms to watch out for in children. We also explain the typical timeline of flu symptoms and when to take a child to the hospital.

The flu is a respiratory illness. It occurs when an influenza virus infects the nose, throat, or, occasionally, the lungs. The symptoms of the flu in children are similar to those in adults. They include:

Some children may also experience vomiting or diarrhea.

Flu is not the same as the common cold. Some key differences between cold and flu symptoms can help a parent or caregiver identify which disease is affecting a child.

Usually, a fever and extreme tiredness accompany the flu. These symptoms are much more unusual in colds.

It is also important to note that the symptoms of the flu can be similar to those of COVID-19, which SARS-CoV-2 — the new coronavirus — causes. If there is a possibility that a child might have COVID-19, it is important to make sure that staff members are aware of this before arriving at a hospital or medical facility.

In most cases, parents or caregivers can treat a child with the flu at home. However, when the child has more severe symptoms or symptoms that persist for longer than normal, they may need to go to the hospital.

According to the Centers for Disease Control and Prevention (CDC), if a child has the following symptoms, they require emergency medical treatment:

  • rapid breathing or difficulty breathing
  • blue tinge to the lips or face
  • ribs pulling in with each breath
  • chest pain
  • severe muscle pain
  • dehydration — signs in children include not urinating for 8 hours or more, having a dry mouth, or producing no tears when they cry
  • not alert
  • seizures
  • fever above 104°F (40°C)
  • in children less than 12 weeks of age, any fever, which is 100.4°F (38°C) or higher
  • fever or cough that worsens or improves and then comes back

This list is not exhaustive. If a parent or caregiver is concerned about any symptoms that do not appear on this list, they should still consult a medical professional.

If a child does require hospital treatment, doctors can use a range of treatments to help them recover from the flu. These include:

  • intravenous (IV) fluids to treat dehydration
  • antiviral medications to combat the flu virus
  • oxygen therapy, if a child is struggling to breathe

According to the CDC, since 2010, 7,000–26,000 children younger than 5 years of age have required hospitalization each year due to the flu.

Children are at risk of developing health complications from the flu. One study looking at

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Sickle cell anemia: Symptoms, treatment, and causes

Sickle cell disease (SCD) is a group of conditions that cause red blood cells to malfunction. Sickle cell anemia is a type of SCD.

Healthy red blood cells are disc-shaped and flexible, which helps them move through blood vessels and deliver oxygen to the body’s cells.

In sickle cell anemia, these red blood cells are crescent- or sickle-shaped, inflexible, and sticky. These traits make them clump together, blocking blood vessels and impairing blood flow. The sickle cells also die early, resulting in a shortage of red blood cells.

This article outlines the different types of SCD. We also describe the symptoms, causes, and treatment options of sickle cell anemia.

Red blood cells contain a protein called hemoglobin, which delivers oxygen to the body’s cells. In all forms of SCD, the red blood cells have an abnormal type of hemoglobin. Doctors refer to this as sickle hemoglobin or hemoglobin S.

Besides hemoglobin S, there are other abnormal variants of hemoglobin. The type of SCD a person has depends on which abnormal hemoglobin genes they inherit from their parents.

Below are the three most common types of SCD.

Sickle cell anemia

Sickle cell anemia is the most common and severe type of SCD. It develops when a person inherits two hemoglobin S genes — one from each parent.

People with sickle cell anemia become anemic. This means that their body does not produce enough red blood cells to supply sufficient oxygen to their cells.

Sickle-hemoglobin C

Sickle-hemoglobin C is a milder form of SCD. It occurs when a person inherits two different types of abnormal hemoglobin genes: one for hemoglobin S, and one for hemoglobin C.

Hemoglobin C causes milder symptoms than sickle cell anemia. As a result, a person with sickle-hemoglobin C usually has a higher red blood cell count and a reduced risk of developing anemia than someone with sickle cell anemia.

Sickle beta-plus thalassemia

Sickle beta-plus thalassemia occurs when a person inherits one gene for hemoglobin S and one gene for beta thalassemia.

Beta thalassemia is a different type of anemia, and the gene comes in two forms: 0 and +. Those with the 0 variant usually have a more severe illness than those with the + variant.

Less common types

Below are the rarer types of SCD.

Sickle-hemoglobin D

Sickle-hemoglobin D occurs when a person inherits one gene for hemoglobin S and one gene for hemoglobin D. The two genes interact in a way that usually results in mild to moderate anemia. People with one of each gene may also experience bouts of pain.

Sickle-hemoglobin O

Sickle-hemoglobin O occurs when a person inherits one gene for hemoglobin S, and one gene for hemoglobin O. The two genes interact to trigger various symptoms ranging from mild to severe.

People with sickle cell trait (SCT) inherit one sickle cell gene from one parent and one normal gene from the other. A person with SCT can pass the trait on to their offspring. If both parents have SCT, there is a

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