The function of red blood cells (RBC) is to deliver oxygen to tissues. The primary goal of RBC administration is either to prevent hypoxia or improve tissue oxygenation. When the circulating red cell mass is reduced due to blood loss, reduced RBC production or increased RBC destruction, red cells are administered as a form of red cell concentrate (packed RBC) for anemia to prevent hypoxia or as whole blood for acute bleeding to restore circulating blood volume to prevent shock. When structurally or functionally abnormal red cells are present in the circulation, removal of those abnormal red cells may be the treatment of choice followed by replacement with normal RBC. Specific and effective transfusion therapy should be carried out in each patient after evaluating clinical indications. This audio conference will present an overview of red cell transfusion and red cell exchange. This program highlights pros and cons of long-term erythrocytapheresis and chronic RBC transfusion in sickle cell patients.