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The presence of increased Hemoglobin F (Hb F) in patients with hemoglobin SS disease (sickle cell disease) indicates a moderate to severe form of the disease. Hemoglobin F is the fetal form of hemoglobin, and its levels typically decrease after birth. In patients with sickle cell disease, elevated levels of Hb F can help inhibit the sickling process of red blood cells, leading to fewer vaso-occlusive crises and reduced anemia in these patients.

Patients with Hb SS genotype and higher levels of Hb F often experience a milder disease course compared to those with lower levels of Hb F; however, significant elevations can still indicate a more severe disease profile due to various genetic factors or adaptations that may lead to the production of more fetal hemoglobin.

In context to the other choices, the implication of mild sickle cell disease or carrier states would suggest lower levels of Hb F, not elevated levels. Therefore, the conclusion that increased levels of Hb F imply a moderate to severe presentation of sickle cell disease aligns with established clinical understandings of the condition and its phenotypic variability.