A recent review of malaria in children with sickle cell disease nicely outlined other ways in which hydroxyurea might combat malaria, including direct antiparasitic activity at high concentrations, and improvement in splenic function [33], but it is unclear whether these effects or an increase in ICAM-1 or TNF-α, which may increase risk of malaria severity, will be seen in children with SCA in Sub-Saharan Africa. This evidence concerns the gene ICAM1 and autosomal dominant cerebellar ataxia.