A global survey of blood transfusion practices for patients with sickle cell disease

BACKGROUND: Sickle cell disease (SCD) affects over 7 million people globally, with blood transfusion remaining a cornerstone of management. However, contemporary transfusion practices across diverse settings remain poorly characterized. We evaluated global transfusion practices for patients with SCD to identify gaps and inform resource prioritization. STUDY DESIGN AND METHODS: We conducted a cross-sectional web-based survey of clinicians and laboratory professionals providing transfusion support for SCD, distributed via email using three professional society's membership lists (July-September 2025). Variables included facility characteristics, pre-transfusion testing capabilities, antigen-matching strategies, transfusion modalities, and barriers to care, stratified by World Bank income classification. RESULTS: After excluding incomplete/duplicate responses, 102 facilities from 39 countries were analyzed; 95 actively treated patients with SCD. Facilities were predominantly public (73%), with 46% in lower-middle-income countries (LMICs). Routine newborn screening was performed by 33% overall (48% high-income countries [HICs] vs. 0% low-income). While ABO/RhD typing was nearly universal, antibody screening was available in only 72% of facilities (0% low-income, 47% LMICs, 98% HICs). Prophylactic RBC antigen matching was performed by 46% (18% LMICs vs. 70% HICs), primarily limited to Rh(CcEe) and K. Automated RBC exchange was available in 44% overall (0% low-income, 25% LMICs, 73% HICs); among facilities with exchange capability, 83% of HICs versus 36% of LMICs could provide exchange within 24 h for acute indications. DISCUSSION: Pronounced income-related disparities exist in SCD transfusion support. Facilities in lower-income settings disproportionately lack antibody testing, prophylactic matching, and timely automated exchange. Targeted infrastructure investment and context-appropriate guidelines are essential for equitable care.