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Transcranial Doppler ultrasound screening and prophylactic transfusions have cut the incidence of overt stroke in sickle cell disease more than tenfold, according to researchers at The Children's Hospital of Philadelphia.

Senior author Dr. Janet L. Kwiatkowski and colleagues recently analyzed the incidence of sickle cell-related strokes and rates of prophylactic transfusions before and after an ultrasound screening program began in 1998. They used data on 475 patients from the 8 years prior to that, and on 530 children for the 8 years afterward.

In their May 3rd online paper in the Journal of Pediatrics, the researchers say that prior to screening there were 21 overt strokes, whereas after screening began there were only 2 (0.67 vs 0.06 per 100 patient-years).

Of the 2 strokes in the later era, 1 was in a child too young for the screening protocol, and the other was in a child with high velocities solely in the anterior cerebral arteries.

"Although the rate of first stroke has declined at our center, there has been a significant increase in the number of children who are undergoing transfusion to prevent stroke," the authors note.

Since the screening program began, the rate of transfusion for stroke prevention has risen from 0.67 to 1.12 per 100 patient-years. The team points out that while regular transfusions "may have the added benefit of preventing other complications of sickle cell disease such as acute chest syndrome and pain, (they) carry the risks of infection, alloimmunization, and iron overload."

"But with early use of exchange transfusion and with blood banking modifications, it is possible to limit the risks of transfusions," Dr. Kwiatkowski told Reuters Health by e-mail. "Further studies to better understand which children with abnormal transcranial Doppler ultrasound will not go on to have a stroke, and thus may not need transfusion therapy, and studies of alternative treatments will be beneficial."

Source: Reuters Health

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