This guideline addresses the specific indications for transfusion in SCD. Transfusions can be given for either acute or chronic complications of SCD. Indications include primary and secondary stroke prevention; acute sickle complications such as sequestration syndromes, red cell aplasia and severe acute chest syndrome. Longer term transfusions may be considered as disease modifying therapy in selected patients after careful consideration of the risks and benefits.

In the perioperative period transfusion is indicated for all sickle genotypes for high risk surgery; for patients with Hb SS and Hb SC undergoing medium risk surgery. The decision to transfuse prior to emergency surgery depends on clinical factors such as the urgency and complexity of surgery.

Transfusions are not routinely required in pregnancy but should be considered where there are medical, obstetric or foetal complications related to SCD; patients who were previously on hydroxycarbamide; multiple pregnancies; worsening anaemia or acute sickle complications.​