• Dependability (This may be reduced because of periodic episodes of sickle cell crisis.)

• Frequent change (Frequent changes of duties can cause stress which can exacerbate the problem.)

• Strength, stamina

• Working in the cold or heat

• Working where there are temperature changes

• Working in wet, humid conditions

• Pain (abdominal, back, joints)

• Joint stiffness and swelling

The functional limitations indicated earlier need to be related to the individual's ability to obtain or maintain employment. There are three things to consider. First, how do the periodic crises affect the ability to work? These crises cause some of the functional limitations indicated earlier along with pain, abdominal pain, shortness of breath, and aching joints. Second, you will need to assess any limitations that have been caused from other organs affected by this disease. Third, you need to consider the difficulty in being hired, given the potential time away from work due to periodic crises.

In adults, mortality is most commonly due to infection or chronic renal failure. There is no peak mortality period in adulthood as there is in childhood, and the overall life span for adults has not been identified. Many patients now survive to middle age and beyond. For any single individual with this disease, ultimate prognosis cannot be predicted. The counselor should focus on vocations using the remaining functional abilities of the individual.