Sir.—A recent article by Buchanan and Glader in the Journal (132:396-398, 1978) prompted us to review the records of 73 children under our care with homozygous sickle cell disease. The children ranged in age from 2 to 18 years, with a mean age of 9.2 years. Leukocyte counts were recorded in all 73 children during the steady state, in 47 during vaso-occlusive crises (88 episodes), and in 26 with bacterial infections (34 episodes). Of the 26 with bacterial infection, three had Diplococcus pneumoniae sepsis and meningitis; one each, Staphylococcus aureus sepsis and osteomyelitis, Salmonella typhimurium sepsis and osteomyelitis, Klebsiella sp sepsis and pyelonephritis, Escherichia coli pyelonephritis, and Diplococcus sepsis and otitis media; two, purulent otitis media; three, S aureus pyoderma and abscess; four, group A β-hemolytic Streptococcus pharyngitis; one, D pneumoniae sepsis and pneumonia; 16 were considered clinically to have bacterial pneumonia.
During the steady state, the mean WBC