This guideline covers the specific indications for transfusion in SCD. Both acute and chronic SCD disorders can be treated with transfusions. Blood transfusions can save lives in sickle cell disease (SCD), but they also come with a risk of morbidity.
Depending on the cause for the transfusion, the need to avoid hyperviscosity, alloimmunization, iron balance, and venous access issues, transfusions can be given as a top-up or exchange transfusion. All patients must have extended red cell antigen typing.
Before being transfused, ABO compatible red cell units must be Rh and Kell matched, HbS negative, and antigen-negative for any clinically significant red cell antibodies. Top-up transfusions require blood that is at least 10 days old, whereas exchange transfusions require blood that is at least 7 days old.
A clinician with experience handling patients with SCD should be involved in the decision to transfuse or not transfuse. All hospitals that are likely to admit patients with SCD should have manual red cell exchange strategies accessible; larger centers should have automated red cell exchange.
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