Transfusion therapy provides many benefits to Individuals with sickle cell disease but may lead to cardiovascular complications, alloimmunization, exposure to infection, and iron overload. Simple transfusion is used to increase oxygen-carrying capacity. Chronic simple transfusion is useful in preventing a number of complications in sickle cell disease. Acute erthrocyte exchange transfusion can reduce the percentage of cells containing sickle hemoglobin while decreasing volume overload and minimizing hyperviscosity. Chronic erythrocyte exchange transfusion reduces iron loading but Increases donor exposure. Directed odnation may reduce alloimmunization and exposure to infection.