The course of babesiosis in a patient with sickle cell anemia may be difficult to predict.
On the one hand, sickle cell anemia is protective against infection from Babesia, similar to its effect on malaria.
However, severe infection with hemolysis can occur:
(1) in transfusion-associated babesiosis
(2) if the patient is immunocompromised (transplantation, chemotherapy, HIV, immunosuppression)
(3) asplenism
A patient with sickle cell anemia undergoing bone marrow transplantation may be at risk, both from the transplantation and from the need for transfusion.
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