Conservative versus aggressive transfusion regimens in sickle cell disease

To the Editor: Vichinsky and coworkers are to be applauded for their article (July 27 issue)¹ reporting that patients with sickle cell disease undergoing general anesthesia and surgery fare just as well with a less intensive transfusion regimen as with a more aggressive approach. However, the authors' study did not include a “no transfusion” arm. Thus, whether some or even most patients with sickle cell disease might not require blood transfusions at all before elective surgery remains uncertain. This point is relevant not only because of the high incidence of alloimmunization and the occurrence of other transfusion-related complications in their.