This patient should receive an erythrocyte transfusion to a target hemoglobin level of 10 g/dL (100 g/L). He has homozygous sickle cell anemia (Hb SS) and must undergo laparoscopic cholecystectomy, a surgical procedure of low to moderate risk. Patients requiring surgery should undergo transfusion before their procedure to avoid complications. Transfusion to a hemoglobin level of 10 g/dL (100 g/L) has been shown to be equivalent to exchange transfusion for low- to medium-risk surgeries. The recent TAPS study showed that, for this surgical risk group, significantly more clinically important complications occurred in the group that did not receive preoperative transfusion (39%) than the group that did receive transfusion (15%). Significantly more serious events were also recorded in the nontransfusion group (30%) than in the transfusion group (3%), most of which were acute chest syndrome (ACS). Erythrocyte transfusions must be given with care in patients with sickle cell disease, because these transfusions are associated with iron overload. In some patients, “hyperhemolysis” occurs because of alloimmune responses to erythrocyte antigens, which leads to a delayed transfusion reaction characterized by hyperbilirubinemia and anemia. Additionally, erythrocyte transfusions that result in hemoglobin levels greater than 10 g/dL (100 g/L) can increase blood viscosity and potentially cause thrombotic complications.

Several multicenter studies have documented the clinical efficacy of transfusion to 10 g/dL (100 g/dL) compared with the more aggressive strategy of exchange transfusion targeting a hemoglobin S level of 30%. Transfusion and exchange transfusion are associated with similar serious surgery-related complications and ACS, but transfusion is associated with fewer transfusion-related complications and exposure to less blood.