A 26-year-old woman with sickle cell disease (HbSS) at 28 weeks gestation has haemoglobin 7.2 g/dL. She has no acute complication. What is the recommended transfusion approach in this asymptomatic anaemia?
- A Prophylactic exchange transfusion to maintain HbS <30%
- B Simple top-up transfusion to maintain Hb ≥8 g/dL
- C No transfusion; this haemoglobin is acceptable in sickle cell disease ✓
- D Hydroxycarbamide (hydroxyurea) to increase fetal haemoglobin production
Correct answer: C. No transfusion; this haemoglobin is acceptable in sickle cell disease
Explanation
Sickle cell disease causes chronic compensated haemolytic anaemia; Hb 7–8 g/dL is typical and is well-tolerated by women adapted to their baseline. Routine prophylactic transfusion is NOT recommended in asymptomatic sickle cell anaemia in pregnancy as it carries risks (alloimmunisation, haemolytic transfusion reactions, iron overload, infection). Transfusion is reserved for acute sickle crises, acute chest syndrome, acute splenic sequestration, or pre-operatively. Hydroxycarbamide is CONTRAINDICATED in pregnancy (teratogenic).
Reference: Williams Obstetrics, 26th ed.
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