LOVE AND HEALTH

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Hi there, tribe member! You’re welcome once again to The Mirror and Reflections, your go-to blog space every day and not just on Tuesdays😁. It’s the second week in the second half of the year, and I hope you’ve been having a good one amidst work, school, and other pursuits. Keep up the positive energy!

Today’s post will take quite a different turn, and I’m happy I got the motivation to dive in this direction, many thanks to one of my friends who asked me a question on WhatsApp about three weeks ago. Actually, this is something I should do more often as a way of creating awareness to the public, beginning with you who is always in my blog space🙏. 

In case you’re wondering what I’ve been going on about😁, we’ll be addressing a health topic today. You might just be asking yourself, why health? Stay with me, I’ll answer that in a minute. First, this blog was born with a faith-based but not just faith-centered vision, meaning that the idea is to write across different walks of life, while still speaking through the lens of faith. One of such other important aspects is what we are going into today- Our Health. 

A second reason will be that I got a question that I believed requires a comprehensive answer which can also come as light to the public and not just the person who asked, and the third will be that I am bringing one of my responsibilities as a Healthcare Professional, a Nurse precisely, into a more practical sense beyond the hospital walls. So, let’s educate or remind ourselves of what we already know, while adding a little more knowledge to what is on the ground. 

May I start with a short back-story so that you can get the entire picture before we dive deep? Thank you for nodding in affirmation. On June 19, 2025, which is known as ‘World Sickle Cell Day’, a day set aside globally to acknowledge people living with Sickle Cell Disease (the Sickle Cell Warriors) and also to create awareness and raise advocacy for improved health, I had done my bit (or so I thought) by sharing a Genotype compatibility awareness flyer on my WhatsApp Status when a friend replied with a question about ‘rhesus factors’ and how it seems there isn’t usually so much emphasis made on it as compared to that of the genotype. 

I began typing a reply, but as I went on, I discovered I might end up writing an entire blog post as a response😁. So, I promised to get back with a reply soon. Right here, we all have the reply in a post titled ‘Love and Health’, which is going to address genotype compatibility and give more volume to what’s up with rhesus factors. I hope all that is to be said can fit into one post, but if not, we’ll have a part 2. I’ve got no worries that you’ll read that as well☺️. 

To begin with, the knowledge of your genotype and rhesus factor goes a long way in ensuring optimal health for yourself right now, and generations after you in the years to come. Yes, I know we already often address genotype compatibility in the context of relationships or choosing a partner to marry, and it’s rightly so. However, despite the ‘loud’ awareness on premarital screening, there is still an alarming rate of annual sickle cell births in Nigeria. This is a serious call for concern, hence the need to sit ourselves, families, and friends down and keep up the reminder about what is at stake. 

Also, there are other contexts where your awareness of these concepts will be needed; adding it to your knowledge base, making sound, informed, and guided choices at the junction of childbirth (still attached to marriage), and even knowing what works or doesn’t work for you in other cases, such as a blood transfusion. The instances here are even more applicable to your blood group and Rhesus status. 

Going back to the statistics, let’s check out a few together. Several studies have shown that approximately 100 million people worldwide live with Sickle Cell Disease (SCD), with the highest burden found in Sub-Saharan Africa. Of this number, Nigeria accounts for about 4 to 6 million people living with the disease, while about 50 million persons carry the sickle cell trait. Do you know what else is there to find out? Of course, I’ll tell you about it! 

There is an estimation of about 300,000 newborns diagnosed with the disease in Sub-Saharan Africa every year, out of which 100,000 to 150,000 of them are born in Nigeria. These statistics imply that almost half of the sickle-cell births happen in Nigeria. Speaking of mortality rate (also known as death rate), there are about 150,000 infant deaths annually due to SCD, and many of these children die before their 5th year of life. This number of infant deaths represents about 8% of total infant mortality. 

Also, I gathered some facts and figures about Hemolytic Disease of the Newborn (HDN), which is a huge complication of the rhesus factor incompatibility. A study from 2020 mentioned that the prevalence of HDN due to rhesus incompatibility in Nigeria is between 2.5% and 11.3%. It was noted that maternal-fetal (mother and baby’s) blood incompatibility contributes significantly to the high infant mortality rate. The sources of all the data listed above will be attached to this post so that we can also go through them and be enlightened. 

I think the above figures should stir up some thoughts in us. What exactly is going on? Why are the numbers so high, and with even a prediction of a likely increase in sickle cell trait prevalence by 100% in Nigeria by the year 2050? Let’s not forget that other than the death rate, the sickle cell warriors also have moments of crisis when they have to literally fight for their lives. To answer these questions, and to actively contribute to what might just be the beginning of the reduction of sickle cell prevalence, we need to go back to a key factor I believe has fueled the number over they years- Falling in Love, Getting into a Relationship, and ultimately, Walking down the Aisle to officially begin the Marriage Union. 

May I quickly establish something before I forget and also clear any misconceptions or doubts you might be having? As an individual, your rhesus factor status is not a problem at all, whether positive or negative. This implies that whether you carry a Rh-positive or Rh-negative status, you are healthy. Also, your Rhesus factor status does not affect your choice of a life partner, meaning you can marry a Rh-positive or Rh-negative individual. However, when you carry the Rh-negative status as a female, there are certain cautions to take as you proceed towards starting a family and having children. We’re still coming back to this in part 2, which will be released next week.  

I hope I have done a bit of good foundation-laying with the points you’ve read above. Now, let’s take more strides forward. What exactly do these Genotype, Blood Group, and Rhesus factor refer to? How do you know what your status is? How can the knowledge guide your choice of a life partner and some other key decisions? These are some of the questions this post, and the sequel will be answering. 

Let’s begin by talking about our Genotype. Your hemoglobin genotype is the specific combination of genes that you inherit, and this determines the structure of hemoglobin in your red blood cell (RBC) Hemoglobin is a protein in Red blood cells that carries oxygen throughout the body, and I believe you already know how significant oxygen is to someone’s existence. Therefore, when the structure of this container (hemoglobin) that is responsible for carrying oxygen is compromised, it becomes a problem. 

Different hemoglobin types account for our different genotypes, depending on the combination we inherit from each of our parents (note that we inherit one from each of our parents). There is the hemoglobin A gene, which is a normal one and is relatively common. Due to some mutation or changes in genes, the structure and resultant function are affected. 

Such a mutation is what gives rise to the hemoglobin S gene and hemoglobin C gene, which eventually results in the respective genotype (gene combinations) found under the sickle cell disease or sickle cell trait when combined. The hemoglobin S changes the shape of the Red Blood Cells (RBCs), which are normally biconcave or disc-like, and then causes the RBCs to become fragile and shaped like a sickle (which is abnormal and does not support the ideal lifespan of the RBCs). We will be checking out these genotype combinations as well, but then, I hope you are getting the explanation🥺. 

Some common genotypes that are found I this part of the world are Genotypes AA, AS, SS, AC, and SC. Also, there is the CC genotype, but this is not very common. In fact, I haven’t met anyone with the CC genotype yet, but I have seen at least one or more people belonging to the other categories. 

Genotype AA: This is what we call the normal genotype, and it is the combination of one normal hemoglobin A gene from one parent and another A gene from the other parent. It is one of the common genotypes. 

Genotype AS: This is the combination of one normal hemoglobin A gene and one sickle cell hemoglobin S gene. People with this genotype are said to be ‘carriers of the sickle cell trait’, but they do not experience the sickle cell anaemia symptoms. They are generally healthy and may experience mild symptoms in rare cases and under conditions such as dehydration and severe physical exertion. 

Genotype SS: This is associated with the ‘Sickle Cell Disease’, and it occurs as a result of inheriting the hemoglobin S gene from both parents. Like it was mentioned earlier, this combination affects hemoglobin production and causes the red blood cells to become crescent or sickle-shaped, instead of the normal biconcave or disc-like shape that they should have.

These sickle-shaped blood cells deliver less oxygen to the body tissues than what is needed, and they also die quicker than normal RBCs. Normal RBCs last for about 120days before they are broken down by the spleen, while sickle-shaped RBCs last for only 10-20 days due to their shape and rigidity. In addition to this, they can easily get stuck in small blood vessels and break into pieces. This leads to an interruption of healthy blood flow and cuts down even more on the amount of oxygen going to the tissues. 

So, due to this condition, there are reduced red blood cells (anaemia) and reduced oxygen to the tissues and organs. It can also lead to vaso-occlusion. Vaso-occlusion (obstruction of the blood vessels) can occur due to the clumping together of sickle-shaped RBCs, which in turn blocks blood flow, thus leading to pain and possible organ damage (some of the symptoms of sickle cell crisis). Other associated issues include infection, shortness of breath, paleness, and tiredness. 

Genotype AC: This combines the normal hemoglobin A gene and the hemoglobin C gene, and these individuals are said to be ‘carriers of the hemoglobin C trait’. Like the AS genotype, they live normal and healthy lives without experiencing significant health issues, except for mild symptoms on rare occasions. 

Genotype SC: This is the combination of hemoglobin S from one parent and hemoglobin C from the other, giving rise to the ‘Sickle-hemoglobin C disease or hemoglobin SC disease’. This genotype can cause a milder form of the sickle cell disease, but symptoms can sometimes be severe, and include risk of infection, vision problems, pain crises, and anaemia. 

Genotype CC: This occurs due to inheriting the hemoglobin C gene from both parents, and this genotype is associated with the hemoglobin C disease. It is also milder than the sickle cell disease, but still exhibits symptoms such as mild to moderate anaemia, jaundice, and an enlarged spleen. 

On a normal day, the spleen filters and removes old/damaged red blood cells from the body, stores red blood cells, and also performs immune function in the body by helping to fight infections. In individuals with sickle cell disease, the spleen can become damaged or affected due to the repeated occurrence of the sickle-shaped RBCs, and this increases the risk of infections. 

Wow, that was quite a long one, but I hope the picture we’re painting is becoming clearer! Having checked the different hemoglobin genotypes, let’s talk about the genotype compatibility before we call it a post for today and then await the next edition. 

When you approach the junction of love, relationship, and marriage, it is important that you truly put love into action by ensuring that you make the best health decision for yourself, your partner, and even your unborn children. You must make a decision that will not bring about a lifetime of pain, regret, and constant health breakdown. Love should compel you to make a decision or choice that won’t affect the destinies of the innocent lives that will come into the world through you. 

Mind you, demonstrating love can mean that you let go of a partner whose genotype is incompatible with yours, knowing that getting into a relationship or getting married to them is likely to bring pain sooner or later. In such a situation, letting the person go is a big way of showing that you care about them. 

I know it is easier said, but it can actually be done, and in fact, it is better done as soon as you’re both aware of your genotype status. It might seem difficult to part ways now, especially considering the investment of time, resources, emotions, and everything into the relationship. However, this is a decision you will be glad you made. Also, just bear in mind that you are saving yourself and some other people from what could result in stressful events later. 

This is why premarital screening is strongly advocated. Also, it is advisable that you know your status early as well, knowing that if you are a carrier of the sickle cell trait, have the sickle cell disease, a carrier of the hemoglobin C trait, have the hemoglobin SC disease, or with the hemoglobin C disease, you need to be extra cautious with your choice of a partner. Don’t delay the process; also, take multiple tests at different facilities if need be, and encourage the other person to do the same to truly ascertain that the coast is clear before the ‘ship’ sails. 

Taking another glance at the complications listed earlier, or if you have ever witnessed a sickle cell crisis or heard of the death of a young sickle cell warrior, you will agree with me that no child or person deserves to live a life of constant pain, back and forth, or even have their existence short-lived due to the decision of the parents. In past times, it could have occurred due to ignorance or errors somewhere. However, we now live in enlightened times, and you must play an active role in making a sound choice. 

I remember seeing a tweet on a friend’s status sometime last week about seeing parents who are having kids with the SS genotype in 2025. The person who reposted jokingly said something like she’ll draw their ears or give them strokes of the cane, something around that. But while that might be a joke, it is also serious. If the people in the olden days didn’t know better, we are better informed now. Still towing that path will mean negligence, and even more, depending on what you choose to classify it as. I feel it would also mean wickedness, and I hope you won’t take offence at the use of that word. 

The genotype compatibility checklist and the possible offspring (children) outcomes are as follows; 

COMPATIBLE

• AA+AA = AA (4) 
• AA+AS = AA (2) & AS (2)
• AA+SS = AS (4)
• AA+AC = AA (2) & AC (2)
• AA+SC = AS (2) & AC (2)
• AA+CC = AC (4)

With the above, it is safe to say that the AA genotype is compatible with all other genotypes. 

INCOMPATIBLE

• AS+AS = AA (1), AS (2) & SS (1)
• AS+SS = AS (2) & SS (2)
• AS+AC = AA (1), AC (1), AS (1) & SC (1)
• AS+SC = AS (1), AC (1), SS (1) & SC (1)
• AS+CC = AC (2), SC (1) & CC (1)
• SS+SS = SS (4)
• SS+SC = SS (2) & SC (2)
• SS+AC = AS (2) & SC (2)
• SS+CC = SC (4)
• SC+SC = SS (1), SC (2) & CC (1)
• SC+AC = AS (1), SC (1), AC (1) & CC (1)
• SC+CC = SC (2) & CC (2)
• CC+AC = AC (2) & CC (2)
• CC+CC = CC (4)
• AC+AC = AA (1), AC (2) & CC (1)

Please, don’t be tempted to say that these outcomes don’t matter, or that they are just combinations in paper or print. These actually determine the genotype and overall quality of life of some people, and more often than not, the offspring produced tend to align with what is said above. Be informed, and make the right decisions. 

I hope you’ve learnt a thing or two about Genotype compatibility through this post. This is where we will draw the curtain for today. The next post will have us talking about the essence of being aware of your blood group and Rhesus status, and its value in marriage and family planning. We’ll also discuss how to care for people living with sickle cell disease, and thriving despite the condition. I know this was a long read, and I appreciate you for reading to the last letter❤️. Don’t forget to share the link with a friend so that they can also learn something. I’ll see you next week!💫

REFERENCES

1. Adesola, A., Akoki, D., Lawal, J., Oyedokun, A., Babawale, A., & Agboola, A. (2024, September 17). Sickle Cell Disease in Nigeria: Why We Must Focus on Advocacy. The Center for Policy Impact in Global Health. https://centerforpolicyimpact.org/2024/09/17/sickle-cell-disease-in-nigeria-why-we-must-focus-on-advocacy/#:~:text=Globally%2C%20Nigeria%20bears%20the%20highest,carrying%20the%20sickle%20cell%20trait.
2. Adigwe, O. P., Onoja, S. O., & Onavbavba, G. (2023). A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa. Journal of Blood Medicine, 14, 367-376.  https://doi.org/10.2147/JBM.S406196
3. Anyanwu, S. (2025, June 19). Nigeria Marks 2025 World Sickle Cell Day: Reaffirming Commitment To Transforming Care And Strengthening Communities. Federal Ministry of Information & National Orientation, Federal Republic of Nigeria. https://fmino.gov.ng/nigeria-marks-2025-world-sickle-cell-day-reaffirming-commitment-to-transforming-care-and-strengthening-communities/
4. Bolaji, A. (2024, July 10). Nigerian ‘sickle cell warriors’ face new foe: climate change. Gavi The Medical Alliance, VaccinesWork. https://www.gavi.org/vaccineswork/nigerian-sickle-cell-warriors-face-new-foe-climate-change
5. Ejimofor, R. O. (2023). Review on Knowledge of Issues of Rhesus Incompatibility among Nigerians. Nigerian Journal of Social Problems and Social Policy Review, 3(2), 26-34. https://nigerianjournalsonline.com/index.php/NJSPSPR/article/view/3360#:~:text=Ejimofor%20Raphael%20Opara-,Abstract,health%20insurance%20in%20the%20country.
6. Erunke, J. (2025, June 10). Nigeria grapples with 150,000 Sickle Cell Cases annually- Harvard medical expert. Vanguard News. https://www.vanguardngr.com/2025/06/nigeria-grapples-with-150000-sickle-cell-cases-annually-harvard-medical-expert/
7. Ogunde, G., Shabi, A., & Akinyemi, J. O. (2025). Statistical exploration of factors associated with the birth of children having sickle cell traits among reproductive-age women in Nigeria. BMC Public Health, 25(419). https://doi.org/10.1186/s12889-025-21559-0
8. Ojo, E. A., & Osuntusa, A. O. (2021). Assessment of Pregnant Women’s Knowledge and Attitude About Rhesus Incompatibility Prevention at Babcock University Teaching Hospital, Ilishan-Remo, Ogun State. International Journal of Academic Research in Business, Arts and Science, 3(6), 5-15. http://doi.org/10.5281/zenodo.4914345
9. Otomewo, L., John-Olabode, S., Okunade, K., Olorunfemi, G., & Ajie, I. (2020). Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Childbearing Age at a Tertiary Hospital in South West Nigeria. Nigerian Journal of Clinical Practice, 23(12), 1759-1766. https://doi.org/10.4103/njcp.njcp_114_20