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), regular (chronic) blood transfusion with iron chelation therapy is suggested for the management of recurrent pain
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- Regular blood transfusion should be offered through shared decision-making, with access to and adherence to regular monitoring of iron overload (e.g. serum ferritin or imaging) and appropriate iron chelation therapy.
- Patients and their families should be informed of the uncertainty regarding the benefits of regular transfusion relative to its potential burdens and risks, including iron overload and alloimmunization.
- For patients who prefer to avoid transfusion-related risks, NSAIDs and opioids may be considered as alternative options for managing recurrent pain.
- Given the cumulative exposure to blood products over the lifetime in individuals with SCD, hepatitis B immunization is recommended.
- Hydroxyurea therapy may be considered as an alternative to chronic blood transfusion for reducing recurrent pain, particularly in settings where transfusion or chelation therapy is limited or unavailable.