Factors that precipitate crises are dehydration, infection, extreme heat or cold and physical or emotional stress. These factors are prevalent in our environment. Early detection and preventive measures are very important in the management of sickle cell disease. To enhance red cell production, patients are offered regular folic acid. To prevent malaria, prophylactic paludrine is given and infection is treated with appropriate antibiotic. Among the anti sickling drugs, hydroxyurea, an inhibitor of ribonucleotide reductase, has been shown to decrease the rate of painful crises probably by reducing adhesion to the endothelium, increasing the proportion of fetal haemoglobin within the cell and reduction in the white blood cells and platelets. Other drugs on trial are butyrate compounds and analogues of azacytidine.