Sickle Cell Awareness Month is observed annually in September, and this year’s theme, ‘Global Action, Low Impact: Empowering Communities for Effective Self-Advocacy’, aims to increase knowledge and understanding of the disease and its impact on individuals and communities. In recent years, the hospital presentation of patients with sickle cell anaemia in the African population has been increasing.

WCBS has supplied blood products for an average of 85 patients with sickle cell disease (SCD) per year between 2022 and 2024.

Due to these patients receiving multiple transfusions, their risk of alloimmunisation (the production of antibodies against donor cells) increases, as they often develop multiple antibodies to high-incidence antigens in the local blood supply.

To stem the spiral effect, WCBS adopts a multi-layered approach, as follows.

  1. Recruiting black blood donors of African descent who are most likely to provide the highest crossmatch compatibility for sickle cell anaemia patients.
  2. Performing extended phenotyping for black blood donors to facilitate the selection of suitable blood products for patients with complex antibody profiles between various WCBS laboratories.
  3. Performing extended phenotyping for the patient and selecting phenotypically-matched blood as far as possible, to ensure compatibility beyond basic ABO and Rh typing, and reduce the likelihood of the patient developing antibodies to antigens on donor cells. Extended phenotyping for both blood donors and patients includes the following antigens: Rh (D, C, E, c, e), Kell (K), Duffy (Fya, Fyb), Kidd (Jka, Jkb), and S and s.
  4. Escalating crossmatch requests for sickle cell anaemia patients to the WCBS Immunohaematology Laboratory during regular business hours, for red cell typing of the patient and finding antigen-negative blood. The Blood Bank will notify the requesting clinician of any delays or special considerations based on the laboratory’s findings.

These methods ensure that SCD patients receive safe and effective transfusions while minimising the risks of alloimmunisation. The same principles apply to the management of patients with thalassemia.

As the clinician of a patient with sickle cell disease, it is essential to notify the Blood Bank as soon as possible in the likely event that a transfusion is required. The patient’s crossmatch sample and request form can be submitted to the Blood Bank up to 48 hours before the prospective transfusion, provided the crossmatch blood sample is less than 24 hours old (or <48 hours old from upcountry) on receipt in the Blood Bank. Please clearly indicate the patient’s diagnosis on the crossmatch request form (e.g., sickle cell anaemia, thalassemia), their transfusion history (if known), and the urgency of the blood requirement. This information will instruct the Blood Bank staff to prioritise the request.

Watch this short video about a SCD patient meeting a WCBS blood donor.

For transfusion-related advice, contact Dr Caroline Hilton, Lead Medical Consultant (Caroline@wcbs.org.za) or Dr Gregory Bellairs, CEO/Medical Director (Greg@wcbs.org.za).