Sickle cell disease (SCD) affects millions of individuals worldwide, and the Sickle Cell Disease Association of
America estimates that 70,000 to 100,000 individuals have SCD and 3 million individuals have the sickle cell
trait. While SCD is known to primarily affect individuals of African American descent, individuals from South
America, the Caribbean, Central America, the Middle East, and the Mediterranean can also have SCD or the
SCD trait. SCD is estimated to affect 1 in 500 African American infants, and 1 in 12 African Americans are
estimated to have the sickle cell trait. SCD is characterized by episodes of acute and chronic pain. By
increasing awareness about SCD and promoting patient education, health care professionals can help patients
and their families cope with SCD and better manage the associated pain. Recurring episodes of acute and/or
severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to
patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point,
most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the
duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others
may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted
to manage the pain. An acute pain event is the most common type of pain, and the onset is typically abrupt. It is
often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled
erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme
temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold
climates, menstruation, and fatigue. Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain
often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of
chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and
chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of
potential addiction and adverse effects. Many studies report that some health care professionals are also
concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may
involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.
Out of this group, which of the following demographic is the LEAST likely to have SCD?
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