Sickle cell disease as a paradigm of immigration hematology: new challenges for hematologists in Europe

W hile it is difficult to underestimate the implications of demographic change for world health, Nevertheless, as genetic diseases are increasingly recognized as a major global health problem, many hematologists are already dealing with a new spectrum of disease which they need to be able to identify and manage. Arguably the disorders which best represent how hematologists have faced the challenges posed by immigration hematology are the hemoglobinopathies, particularly sickle cell disease. The implications are, however, much wider than the direct challenge of adapting services to meet our patients' needs. We also have to consider the needs of the vast numbers of patients in the less privileged countries where these disorders are endemic: it is sobering to realise, for example, that for every birth of a child with sickle cell disease in Europe, there are more than 90 in Africa! Increasing prevalence of previously rare disorders in Europe also requires changes to education and training, not only of hematologists, but of all physicians, medical students, paramedical staff and a wide variety of non-medical professional organizations indirectly involved in supporting patients with chronic disease. This article discusses the changing patterns of sickle cell disease prevalence and the implications for screening, service provision, education and training; as well as the opportunities for forging global networks to work towards improving access to medical care for all affected individuals.