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Table 5 Recommendations to decrease the risk of alloimmunization

From: Organizing national responses for rare blood disorders: the Italian experience with sickle cell disease in childhood

Recommendations Evidence
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. C
Pre-storage leukodepletion of RBCs is recommended to reduce febrile reactions and complications due to cytokine release. C
All patients who have previously performed red cell transfusions should be periodically checked for alloantibodies (they can cause a delayed transfusion reaction). C
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. C
Use blood negative for hemoglobinopathies. Each center must activate a strategy suited to avoid transfusing blood of carriers of Hemoglobin S. C