Management strategies for the older adult with SCD. The overarching principle of care for adults with SCD is regular comprehensive review, sometimes known as the “annual review,” using the approach as outlined. During the review, aggregate supportive therapies hydroxycarbamide plus or minus EPO, blood transfusion, and iron chelation therapy, should be discussed and offered if appropriate. The comprehensive review is also an opportunity to provide patient information on new therapies and research studies such as stem cell gene therapy and transplantation.