EDITORIAL COMMENT": These authors have previously reported the importance of sickle cell anaemia as a cause of maternal mortality in Bahrain (A). We have accepted this paper for publication although sickle cell anaemia is rare in Australia so that our readers can see the lesson learnt from this very large experience of 571 cases, namely that prophylactic blood transfusion is not indicated unless the haemoglobin value falls below 6 g/dL. We presume that all of these patients would require blood to be cross-matched and available at delivery in case of postpartum haemorrhage.

Summary: In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups.

A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well-being with an additional benefit of reducing the incidence of transfusion related crises and other complications.