ASH guidelines discussed in this review8
| Questions . | Recommendations . | Grading of recommendations . | Remarks . |
|---|---|---|---|
| Red blood cell antigen profile obtained before transfusion | ASH suggests: an extended RBC antigen profile for ABO/RhD C/c/E/e K Jka/Jkb, Fya/Fyb, M/N S/s at the earliest opportunity | Conditional recommendation based on very low certainty in the evidence about effects | Availability to all hospitals Genotyping preferred over serologic phenotyping, especially for Fyb decision matching and C partial characterization |
| ABO/RhD-matched RBCs versus extended matching | ASH recommends: prophylactic RBC antigen matching for ABO/RhD and Rh(C, E or C/c, E/e) | Strong recommendation based on moderate certainty in the evidence about effects | Extended red blood cell matching (Jka/Jkb, Fya/Fyb, S/s) may provide further protection Partial C should be transfused with C-negative |
| Use of immunosuppressive therapy | ASH suggests: immunosuppressive therapy for high risk of AHTR or severe history of DHTR | Conditional recommendation based on very low certainty in the evidence about effects | A shared decision-making process is critical |
| Transfusion of pregnant patients with SCD | ASH suggests: either prophylactic transfusion at regular intervals or standard care (when clinically indicated) | Conditional recommendation based on very low certainty in the evidence about effects | Insufficient evidence to recommend a strategy of prophylactic transfusion rather than standard care |
| Preoperative transfusion | ASH suggests: preoperative transfusion over no preoperative transfusion in patients requiring general anesthesia lasting longer than 1 hour | Conditional recommendation based on very low certainty in the evidence about effects | Case-by-case decision according to risk level of surgery, baseline total Hb, disease severity |
| Questions . | Recommendations . | Grading of recommendations . | Remarks . |
|---|---|---|---|
| Red blood cell antigen profile obtained before transfusion | ASH suggests: an extended RBC antigen profile for ABO/RhD C/c/E/e K Jka/Jkb, Fya/Fyb, M/N S/s at the earliest opportunity | Conditional recommendation based on very low certainty in the evidence about effects | Availability to all hospitals Genotyping preferred over serologic phenotyping, especially for Fyb decision matching and C partial characterization |
| ABO/RhD-matched RBCs versus extended matching | ASH recommends: prophylactic RBC antigen matching for ABO/RhD and Rh(C, E or C/c, E/e) | Strong recommendation based on moderate certainty in the evidence about effects | Extended red blood cell matching (Jka/Jkb, Fya/Fyb, S/s) may provide further protection Partial C should be transfused with C-negative |
| Use of immunosuppressive therapy | ASH suggests: immunosuppressive therapy for high risk of AHTR or severe history of DHTR | Conditional recommendation based on very low certainty in the evidence about effects | A shared decision-making process is critical |
| Transfusion of pregnant patients with SCD | ASH suggests: either prophylactic transfusion at regular intervals or standard care (when clinically indicated) | Conditional recommendation based on very low certainty in the evidence about effects | Insufficient evidence to recommend a strategy of prophylactic transfusion rather than standard care |
| Preoperative transfusion | ASH suggests: preoperative transfusion over no preoperative transfusion in patients requiring general anesthesia lasting longer than 1 hour | Conditional recommendation based on very low certainty in the evidence about effects | Case-by-case decision according to risk level of surgery, baseline total Hb, disease severity |
AHTR, acute hemolytic transfusion reaction.