Table 5 Recommendations to decrease the risk of alloimmunization

Perform a wide erythrocyte antigenic phenotype (ABO, Rh, Kell, Duffy, Kidd, Lewis, Lutheran, P, and MNS) before the first transfusion, especially if you plan to establish a chronic transfusion program; physicians, health care providers, and the patient or family should have a copy of the same phenotype.

Pre-storage leukodepletion of RBCs is recommended to reduce febrile reactions and complications due to cytokine release.

All patients who have previously performed red cell transfusions should be periodically checked for alloantibodies (they can cause a delayed transfusion reaction).

Preferably use “fresh” blood (<3 days of life of RBCs) to minimize hypoxia during the procedure and to reduce the consumption of RBCs in chronically transfused patients while minimizing iron overload.

Use blood negative for hemoglobinopathies. Each center must activate a strategy suited to avoid transfusing blood of carriers of Hemoglobin S.