Premium
How I manage sickle cell patients with high transcranial doppler results
Author(s) -
Brewin John,
Kaya Banu,
Chakravorty Subarna
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14850
Subject(s) - transcranial doppler , medicine , stroke (engine) , stroke risk , disease , intensive care medicine , sickle cell anemia , ischemic stroke , mechanical engineering , ischemia , engineering
Summary Stroke is one of the most severe complications to affect children with sickle cell anaemia ( SCA ). Transcranial doppler ( TCD ) is an accurate and non‐invasive method to determine stroke risk. Randomised controlled trials have demonstrated the efficacy of chronic transfusion therapy in stroke prevention based on risk stratification determined by TCD velocities. This has led to the regular use of TCD monitoring for children with SCA in order to determine stroke risk. Significant resource allocation is necessary to facilitate training, quality assurance and failsafe arrangements for non‐attenders. In a subgroup of patients, chronic transfusions for primary stroke prevention can be replaced by hydroxycarbamide therapy, provided careful monitoring is undertaken; including repeat TCD studies at frequent intervals. The authors propose an evidence‐based algorithm for the management of abnormal TCD velocities and discuss the role of this test in other clinical contexts, such as in Haemoglobin SC disease.