Recommendations for the Management and Prevention of Transfusion Complications

Although the literature summarized and described in the evidence table is of very low quality in most of the areas relating to transfusion complications, the expert panel opted to provide several recommendations based on extrapolation from transfusion literature on non-SCD populations, in vitro data, and the clinical expertise of the panel members. The panel members felt that clinicians in the field needed guidance to manage transfusion complications in patients with SCD and a comprehensive overview of this management.

Recommendationsfor Both Children and Adults

Obtain patient transfusion history to include locations of prior transfusions and adverse effects. (Consensus-Panel Expertise)
Ask the blood bank to contact hospitals where patient reported receiving previous transfusion therapy to obtain transfusion information.
(Consensus-Panel Expertise)
RBC units that are to be transfused to individuals with SCD should include matching for C, E, and K antigens.
(Moderate Recommendation, Low-Quality Evidence)
Consult the blood bank for a workup of a possible DHTR in a patient with any of the following signs or symptoms: acute anemia, pain, or jaundice within 3 weeks after a blood transfusion.
(Strong Recommendation, Moderate-Quality Evidence)
In patients with SCA who are not chronically transfused and who are therefore at risk for hyperviscosity,avoid transfusing to a target hemoglobin above 10 g/dl (unless the patients are already on chronic transfusions or have low percent HbS levels).
(Moderate Recommendation, Low-Quality Evidence)
In patients who receive chronic transfusion therapy,perform serial assessment of iron overload to include validated liver iron quantification methods such as liver biopsy,or MRI R2 or MRI T2* and R2* techniques. The optimal frequency of assessment has not been established and will be based in part on the individual patient’s characteristics. (Strong Recommendation, Moderate-Quality Evidence)
Administer iron chelation therapy, in consultation with a hematologist, to patients with SCD and with documented transfusion-acquired iron overload.
(Moderate Recommendation, Moderate-Quality Evidence)