The patient’s red blood cells will be discarded and everything else will be given back plus they will receive more red blood cells. The goal of this treatment is to reduce the percent of sickle hemoglobin from >95% to < 30%.
The need for transfusion is determined by sickle cell severity, baseline hemoglobin, and overall risk of surgery. Some more mildly affected patients may not need transfusion prior to surgery. This should be discussed with your sickle cell healthcare provider.
If acute chest syndrome becomes severe, requiring intensive care unit (ICU) treatment, exchange transfusion is recommended with similar goals as acute stroke.
Patients with hemoglobin SC disease or sickle beta plus thalassemia may not require transfusions as their baseline hemoglobin is higher than hemoglobin SS.
The spleen enlarges in size to accommodate the red blood cells and this can cause severe anemia. IV fluids and transfusion seem to stimulate the spleen to release the trapped red blood cells. Once the spleen releases the red blood cells, they return to circulation returning the hemoglobin to baseline.
Clinical research trials have shown that monthly transfusions can prevent strokes from recurring or from ever occurring in high-risk patients. These recurrent transfusions reduce the percent of sickle hemoglobin in circulation, preventing further events.
