The controversial role of red cell transfusions for sickle cell pain

PURPOSE OF REVIEW: Red cell transfusions are one of the most common and important therapies used for patients with sickle cell disease (SCD). For prevention of strokes, there is abundant evidence that transfusions are efficacious, whereas for other indications, such as prevention of pain, there are less data. Nonetheless, with few therapeutic options, the use of transfusion for prevention of acute pain has increased in children and adults with SCD without a clear understanding of its benefits. RECENT FINDINGS: Although it makes conceptual sense that red cell transfusions would prevent pain that arises from vaso-occlusion, we now know that the mechanism of pain is more complex than vaso-occlusion alone. Recent taxonomies recognize a chronic pain syndrome that is both common in adults with SCD and affects the presentation of acute pain. It is not known if acute pain on the background of chronic pain responds differently to sickle cell therapies, such as hydroxyurea and blood transfusion. SUMMARY: In this review, we will examine the studies that have investigated whether red cell transfusions are efficacious for preventing pain. In the absence of high-quality data that specifically addresses this question, we will outline our approach, which might soon change with new drugs and curative therapies on the horizon.