Sickle cell disease is an autosomal recessive condition that manifests as multisystem ischemia and infarction, as well as chronic hemolytic anemia.

There are multiple forms of skeletal involvement in this case: H-shaped vertebrae, osteonecrosis of pelvic bones and bilateral avascular necrosis of the femoral heads. 

H-shaped vertebrae (codfish) are a characteristic finding of sharply delimited central endplate depression, seen in approximately 10% of patients with sickle-cell anemia, and results from microvascular endplate infarction.

Hepatosplenomegaly is also noted, which seen in some hematological disorders and chronic anemias.