Sickle cell disease in Malay ethnicity is uncommon, with few cases been reported only in Malaysian Indians. Detecting sickle haemoglobin in patients with osteoarticular manifestation is not as simple as those with haemolysis
crisis, due to its extremely low incidence in this country. We hereby report a case of a 19-year-old Malay female
who presented with a long-standing history of disabling movement of both hip joints, intermittent painful swollen
right elbow, and chronic back pain. Imaging investigations revealed features of chronic osteomyelitis and avascular
necrosis while blood investigations demonstrated features of mild normochromic normocytic anaemia and extravascular haemolysis. Further blood smear and haemoglobin analysis eventually confirmed the presence of homozygous
sickle haemoglobin manifesting as sickle cell anaemia. Our case has highlighted the importance of prompt identification and thorough evaluation of the cause of anaemia in a patient with disabling chronic osteoarticular problem.