Sickle-cell disease is caused by the substitution of a single amino acid in the hemoglobin protein of red blood cells; in homozygous individuals, all hemoglobin is of the sickle-cell (abnormal) variety. When the oxygen content of an affected individual's blood is low (at high altitudes or under physical stress, for instance), the sickle-cell hemoglobin molecules aggregate into long rods that deform the red cells into a sickle shape (see Figure 5.21). Sickled cells may clump and clog small blood vessels, often leading to other symptoms throughout the body, including physical weakness, pain, organ damage, and even paralysis.
