Challenges that need to be overcome in blood transfusion, especially in SCD, include:
a. Adopting molecular genotyping as the standard in blood transfusion therapy.
b. Advancing new generation, anti-oxidant hemoglobin-based oxygen carriers (HBOCs) for use in emergencies such as trauma, stroke, acute hemolysis, and in transfusion in SCD and related disorders. In SCD, HBOCs have the capacity to not only serve as substitutes to donor RBC, but to prevent polymerization of Hb S and sickling, by sparing recipient hemoglobin-bound oxygen and leaving Hb S mostly oxygenated.
c. Evaluation of transfusion as disease-modifying therapy in SCD.