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Updated: May 30, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Red blood cell transfusion in pediatric patients with severe chronic anemia: how slow is necessary?
Anurag K Agrawal1, Edmund Hsu, Keith Quirolo
1Children's Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA. aagrawal@mail.cho.org
Abstract:
Historic practice recommends slow transfusion for children with chronic anemia and hemoglobin less than 5.0 g/dl due to the theoretical risk of transfusion-associated circulatory overload (TACO). In our pediatric intensive care unit (PICU), we have been utilizing a more liberal transfusion practice in patients without underlying cardiopulmonary disease, and a faster transfusion rate appears safe in this population. Rate of transfusion must be based on multiple factors including convenience, timeliness of procedures and transport to an appropriate care facility, risk of alloimmunization and wastage of blood, stress for the family, and need for PICU monitoring.
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