This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Medical, surgical and gynaecological illness complicating pregnancy, Subject name: Gynaecology & Obstetrics
Blood transfusion is indicated in following condition with sickle cell anemia 
Select and explain. 
A. Frequent sickling episodes, B. Twin pregnancy, C. Poor obstetrical outcome, D. All of the above
D: All of the above
Answer: D: All of the above 
Explanation: Indications of Blood transfusion in Sickle Cell Anemia Frequent sickling episodes Twin pregnancy Poor obstetrical outcome Severe anemia Blood transfusion replaces the abnormal cells with normal red cells The objective of transfusion is to keep the hematocrit value above 25% and concentration of Hb-S under 50% Prophylactic transfusions during pregnancy remain controversial Reference: Textbook of Obstetrics; Sheila Balakrishnan; 2nd edition; Page no: 291