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John F. Bertles, MD

Arch Intern Med. 1974;133(4):538-543.

Abstract
The basic physical mechanism responsible for sickling is linear aggregation of deoxygenated molecules of sickle hemoglobin (Hb S) into long fibers within erythrocytes. Although hemoglobin molecules are held together in fibers by relatively weak bonds, bundles of these fibers are strong enough to distort erythrocytes containing them into the well-known sickle-like shapes. A combination of x-ray diffraction studies and electron microscopy has shown that each fiber is made up of six strings of Hb S molecules "in register." The effects of other hemoglobins present in red blood cells along with Hb S on sickling have improved conceptualization of how Hb S molecules fit together. When contact regions have been precisely identified, attempts to devise means of preventing aggregation and sickling can be carried out with a high degree of precision.

Author Affiliations
New York

From the Hematology Division, Medical Service, St. Luke's Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York.

Footnotes
Received for publication June 15, 1973; accepted June 26.

Reprint requests to Medical Service, St. Luke's Hospital Center, Amsterdam Avenue at 114th Street, New York 10025 (Dr. Bertles).

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