Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of Cochrane reviews.

What was studied

This overview summarized Cochrane reviews on red blood cell transfusion in sickle cell disease. Transfusion treats complications or helps prevent them. It was compared with no transfusion, standard care and other drugs. Restrictive and liberal strategies were also compared. The Cochrane database was searched on 3 June 2026. Review quality was rated with AMSTAR. Certainty came from GRADE. 17 reviews were found. 9 trials with 1502 participants gave data.

What they found

Most evidence was of very low certainty. Death risk may show little or no gap. In children at high risk of stroke, long-term transfusion probably lowers stroke risk. It may also lower acute chest syndrome, painful crisis and silent infarcts. In children with normal Doppler velocities, it may raise iron overload. In pregnant women, it may lower painful crisis. Hydroxyurea with phlebotomy may raise painful crisis and serious events versus transfusion.

What it means for patients

The authors say the overview supports transfusion to prevent stroke. This is for children and teens at high risk. They say it may lower other harms there. They note a lack of high-quality evidence in adults.

Why it is not certain yet

Certainty was variable, with most evidence very low. Most trials were in children with the HbSS type. Outcomes had wide confidence ranges. Reporting of patient-relevant outcomes was often incomplete.

Source

Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of Cochrane reviews.

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