We describe a 7-year-old female patient with SCD (Hb SS) with D+, C+(partial), E-, c+(partial), e+(partial), V + VS+, hrB-, hrS + RBC phenotype who developed multiple RBC antibodies and suspected DHTR after her second lifetime transfusion, in the setting of severe anemia and ACS. Here, AGFG1 is linked to anemia (phenotype).