Transfusion is one of the fundamental treatments in complications of sickle cell anaemia, a disease with peculiar features requiring an appropriate transfusion policy. Owing to the higher risk of vascular occlusion it carries, simple blood transfusion is indicated only for acute anaemia and for the very rare long-term transfusion programmes. In patients with severe occlusive and/or septic accidents, the risk of decompensation makes it mandatory to promptly reduce the sickle cell concentration; this is achieved by exchange transfusion the modalities of which are described by the authors. General anaesthesia also requires exchange transfusion in volumes that depend on the risk incurred. Finally, some patients benefit from a long-term transfusion programme. Potentially repeatable transfusions imply the use of phenotypes and leucocyte-freed red cell concentrates as well as detection and prevention of viral infections transmitted by transfusion. This article summarizes the recommendations that can now be made concerning the use of perfusion in the management of sickle cell anaemia.