This study is part of a long term evaluation of sickle cell disease (SCD) as a paradigm for immunosuppression. Serum was obtained from 43 SCD patients during the steady (healthy) state. Peripheral blood mononuclear cells (PBMC), separated by density gradient were obtained from 8 normal healthy donors. PBMC were utilized in assays directly or as a source for obtaining, total T (CD3) and helper T (CD4) cell populations separated by specific T cell columns. Standard in vitro phytohemagglutinin (PHA) stimulation of lymphocyte cultures was done with culture media containing 10% SCD serum, as compared to normal pooled O, Rh+ (O+) serum. Mitogenic responses were expressed as mean counts per minute (cpm) and stimulation index of triplicate cultures. Results revealed PHA responses were positive in all experiments when a standard stimulation index of 10 or greater was used as a test parameter for comparison. Positive results were demonstrated in 43/43 (100%) of triplicate cultures regardless of serum type in all experiments. Conversely, by using mean cpm as the test criterion, suppression of PHA response was shown in SCD serum supplemented cells as follow; 36/43 (84%) of PBMC, 35/43 (81%) of CD3 and 37/43 (86%) of CD4 cultures. The degree of suppression ranged from > 10% to 98% in individual experiments, as compared to O+ serum. Inhibitors of normal T lymphocyte in vitro PHA response appear to be present in a significant percentage of SCD sera even during the healthy state of disease. Type 2 cytokines which suppress cell mediated immunity would seem to be the most likely inhibitory agents.