 We had Mr. Ahmad, a case of severe sickle cell disease, who had recurrent painful crisis, who had recurrent transfusion requiring anemia and episodes of jaundice. He was being hospitalized every now and then with complication. He also had received multiple transfusions and had undergone a splenectomy several years before. Despite optimal medical therapy and having had a splenectomy done, he continued to have severe sickle cell related target organ damages. The donor for Mr. Ahmad was his younger sister and it was really challenging to collect stem cells. We had to make sure that the parents understood completely the potential risks involved. The child was given sedation and stem cells were harvested by our blood bank affairs team headed by Dr. Shivram. Although pediatric stem cell transplants are not new to us, we faced a unique problem in this particular case because this was an Iraqi child. We had the problems of how to communicate with this child. That was our first problem. Then there was a huge mismatch between in the age of the patient and the age of the donor. While our patient was 18 years age and weighed 60 kg, our donor was a small child three years of age who weighed only 18 kg. The child donor with the weight of 18 kg had total blood volume of only about 1.3 liters from whom we had to process 8 to 10 liters of blood. This would be impossible but in a single city we therefore decided to do it in multiple cities and cryopreserve the stem cells collected. Sickle cell disease is an inherited blood disorder characterized by repeated painful vasoclyzocrisis, recurrent anemias, recurrent episodes of jaundice and in some children severe infections requiring hospitalization. There are some patients of sickle cell disease who with optimal medical therapy which is administration of folic acid, antimicrobial prophylaxis, age appropriate vaccination and regular usage of hydroxyurea. They do fairly well and have good quality of life. So, in addition to sickle cell disease of such high severity, the only potential cure for such individuals is allogenic bone neurotransplantation. In consultation with our clinical hematologist and the pediatric team, we felt the pediatric ICU would be a good place to handle such difficult cases. The child was sedated by the pediatric intensivist. So, that was the only way we could probably get the cooperation of the child for a period of about two to three hours which the procedure lasts. Then, but the problem we face in a sedated child is that citrate toxicity cannot be recognized. In a normal patient they will tell us about tingling, numbness, these complications which can occur but this cannot be recognized by an unconscious patient. We therefore had to use the cardiac monitor and depend on the ECG tracing to look for evidence of citrate toxicity. Then, another problem we encountered was the volume of blood that would go into the aphorosis machine from this child would be too large for the child to tolerate. We therefore first connected an RBC back of the same group to the machine to fill the dead spaces and then connected the patient for aphorosis procedures. It was indeed a very challenging exercise to collect stem cells from such a young girl. Mr. Ahmad underwent an actually identical allogenic bone marrow transplantation. He is now several months post-transplantation doing very well. He is not needing transmissions. He has not had hospitalizations because of pain-free crisis and all his symptoms are non-existent post-transplantation.