Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of sickle-cell disease in children and adolescents
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In children and adolescents (aged 0–19 years) with sickle-cell disease (SCD) and a clinical diagnosis of acute chest syndrome (ACS), blood transfusion in combination with standard therapeutic interventions is suggested rather than standard therapeutic interventions alone.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- Blood transfusion may improve oxygenation, which is a critical outcome in children with ACS, particularly in the presence of hypoxaemia and anaemia where a dose–response effect may be observed.
- The decision to initiate transfusion should be guided by the severity of ACS symptoms, including the presence of severe hypoxaemia, severe anaemia, stroke or clinical deterioration.
- In patients without hypoxaemia or a significant drop in haemoglobin, the potential risks of blood transfusion (e.g. alloimmunization, iron overload, transfusion reactions) may outweigh the uncertain benefits, and some patients may reasonably choose to decline transfusion.
- Shared decision-making with patients and caregivers is essential, taking into account clinical presentation, transfusion risks and patient values and preferences.