Hyperbaric Oxygen Therapy in Sickle Cell Disease: A Narrative Review of Mechanisms, Clinical Applications, and Future Directions

Sickle cell disease (SCD) is characterized by recurrent vaso-occlusion, hemolysis, and chronic inflammation, leading to acute painful crises and progressive organ damage. Despite standard supportive and disease-modifying therapies, many complications remain difficult to manage. Hyperbaric oxygen therapy (HBOT) increases dissolved oxygen delivery to hypoxic tissues and may reduce sickling and ischemia-reperfusion injury. This narrative review summarizes the mechanistic rationale and available clinical evidence for HBOT in SCD-related complications, including bone disease, chronic leg ulcers, ophthalmic ischemia, and priapism. Current evidence is limited to case reports, small series, and early-phase studies with heterogeneous protocols. Reported benefits include improved pain control and tissue healing in selected patients. HBOT appears generally well tolerated, but its role remains undefined. Prospective, controlled trials are needed to establish efficacy and optimal use.