We examined mean corpuscular volume (MCV), fetal hemoglobin (HbF) levels, and severity of clinical disease in 81 patients with sickle cell anemia from various regions of Saudi Arabia. We found that patients from eastern Saudi Arabia had less severe symptoms, higher mean Hb levels, and lower MCV than patients from other regions. Using a severity index, calculated as the mean value of individual symptoms and physical signs in patients in each region, we found that less severe symptoms were associated with lower MCV. High HbF levels were not confined to Eastern Province patients but were seen in other regions. There was a statistically significant inverse correlation between HbF% and the severity index. We also found that only two of the 24 minimally symptomatic patients had an HbF level less than 18%, whereas among the 57 severely symptomatic patients, 14 (25%) had an HbF level less than 18%, confirming the protective value of a certain minimum level of HbF.

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