What is the best approach to blood transfusion in sickle cell disease? A scientometric analysis and literature review

BACKGROUND: Blood transfusion remains a cornerstone in the management of sickle cell disease (SCD); however, it is frequently complicated by red cell alloimmunisation. A significant debate persists within the scientific community regarding the optimal strategy to mitigate this risk: the traditional, pragmatic approach of serologic phenotyping versus molecular genotyping, which is technically superior yet more resource-intensive. OBJECTIVES: This mini-review aims to map the framework of this scientific debate and synthesize current evidence through a dual methodology. METHODS AND MATERIALS: A scientometric analysis was conducted on 224 articles indexed in Scopus and Web of Science using the Bibliometrix package for R, followed by a structured narrative review of 26 selected studies. RESULTS: The scientometric findings confirm growing interest in this topic, identifying two distinct yet interconnected research clusters that reflect the ongoing dialectic between phenotyping and genotyping, with the latter emerging as a 'hot topic' over the past decade. The narrative synthesis highlights a predominance of evidence supporting genotyping as the most accurate approach to preventing alloimmunisation, particularly given the high prevalence of RH system variants in individuals with SCD. In contrast, cost-effectiveness analyses and implementation studies underscore substantial financial and logistical barriers that favour a more pragmatic, stepwise approach. CONCLUSION: We conclude that the future of transfusion safety in SCD does not lie in a binary choice but rather in a synergistic and stratified integration of both strategies. Implementing protocols that target genotyping for high-risk patients, while simultaneously optimising the use of extended phenotyping, represents the most promising pathway to balance safety, cost and accessibility-ultimately ensuring the best possible transfusion therapy for this vulnerable population.