Sickle cell anemia (SCA) is an autosomal recessive genetic disorder, characterized by chronic hemolyticanemia and affect oral soft and hard tissues, the clinical finding related to anemia affecting of oral mucosa such as paleness oral mucosa, some cysts and apparently oral ulcers or ischaemic ulcers due to occlusion of some mandibular vessels as a result of reduction of blood supply this cross sectional - study conducted in ManagilPediatric Teaching Hospital, about 80 smears were collected from buccal mucosa of sickle cells anemia patients there was no significant difference were found of SCA patients according to the gender regarding Cytological Atypia , there was significant correlation between the Age and Cytological Atypia in SCA patients and finally the Cytological Atypia of oral mucosa in SCA patients were detected in 87% of SCA patients 18% were mild (+) , 42 % were moderate(++) and 27% were marked (+++).