Sickle Cell Disease (SCD): when is blood transfusion indicated?

Abstract

This is a review of the literature as regards the indications for blood transfusion in SCD, complications associated with these transfusions and how to reduce these complications in SCD.The objectives of blood transfusion in SCD include the correction of anaemia and the reduction of the circulating Haemoglobin S level to less than 30%.Thus the indications include prophylaxis for the prevention of stroke especially in childhood.The use of exchange blood transfusion is highly advocated inorder to reduce the level of Haemoglobin S to less than 30%. Conditions such as acute chest syndrome and acute exacerbation of severe anaemia in SCD with hepatic and splenic sequestration also benefit from simple transfusion. Elective surgical conditions; aplastic crisis due to parvovirus B19, in which the packed cell volume is marked reduced; and pregnant multigravida all benefit from simple transfusion to correct the anaemia, and restore the value of the steady state packed cell volume.

Complications that may occur due to blood transfusion include alloimmunization to minor red cell antigens ( C, E and kell) and iron overload.. Inorder to minimize complications the rational use of blood transfusion is advocated, in addition to having appropriate and extensive crossmatching techniques to detect minor antigens.Also advocated is the need to prevent iron overload in SCD patients, if there is an increasing frequency of transfusion.

Keywords: Sickle Cell Disease, Bloodtransfusions, Indications