Simple (Top-Up) Blood Transfusion Blood transfusion is indicated if:
- There are acute symptoms of anaemia, such dyspnoea, tachycardia, severe weakness
- Haemoglobin level is < 6g/dl
- Haemoglobin level has dropped by > 2g/dl below the steady-state value.
Note: Because the cardiovascular system adjusts to the chronic anaemia, blood transfusion is not routinely indicated in steady state SCD simply for the reason that haemoglobin level is below 8–10g/dl.
Exchange Blood Transfusion
Venesection to reduce the proportion of HbS red cells with transfusion of normal HbA blood is often beneficial in the treatment or prevention of life-threatening and other manifestations of sickle cell disease 5. Hence, the aim in this process of exchange blood transfusion (EBT) is to reduce HbS to 30%. Exchange blood transfusion can be done manually or automatically with a red cell apheresis machine.
Indications for Exchange Blood Transfusion
- Cerebrovascular Accidents (CVAs)
- Acute Chest Syndrome (ACS)
- Prior to major surgery
- Multi-organ failure, including Systemic Marrow Fat Embolism (SMFE)
- Multiple pregnancies
- Prevention of recurrent stroke.
Relative Indications for Exchange Blood Transfusion
- Intractable or very frequent severe crises
- Major priapism unresponsive to other therapy.