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Published on: March 14, 2017
Transcranial Doppler changes in children with sickle cell disease on transfusion therapy
Caterina P Minniti1, Vinod K Gidvani, Dorothy Bulas
1Division of Hematology/Oncology, Children's National Medical Center, Washington, DC 20010, USA. cminnitti@cnmc.org
Insights
Transcranial Doppler (TCD) monitoring shows good correlation with MRAs in children with sickle cell disease (SCD) undergoing transfusions. Persistently abnormal TCD velocities indicate ongoing vasculopathy, suggesting stroke risk.
Area of Science:
- Neurology
- Pediatrics
- Hematology
Background:
- Sickle cell disease (SCD) poses a significant risk for stroke in children.
- Transcranial Doppler (TCD) is established for initial stroke risk screening in SCD.
- The utility of TCD for monitoring children with SCD during transfusion therapy remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of Transcranial Doppler (TCD) in monitoring children with sickle cell disease (SCD) receiving transfusions.
- To assess the correlation between TCD findings and magnetic resonance angiograms (MRAs) in this patient group.
Main Methods:
- Seventeen children with SCD undergoing transfusion therapy were evaluated using both TCD and MRA.
- TCD velocities were measured and compared with MRA results.
- Changes in TCD velocities during transfusion were analyzed in relation to MRA findings.
Main Results:
- Patients with normalized TCD velocities showed normal and stable MRAs during transfusions.
- Persistently abnormal TCD velocities correlated with abnormal MRAs, indicating ongoing vasculopathy.
- While TCD velocities decreased with transfusions, they rarely normalized in patients with abnormal MRAs.
- Low TCD velocities (<70 cm/s) were associated with MRA-detected vasculopathy, highlighting a potential stroke risk factor.
Conclusions:
- TCD monitoring demonstrates a strong correlation with MRA findings in children with SCD receiving transfusions.
- Persistently abnormal TCD velocities during transfusions suggest ongoing cerebrovascular disease and potential stroke risk.
- TCD is a valuable tool for monitoring disease progression and guiding management in pediatric SCD patients on transfusions.
Abstract:
Transcranial Doppler (TCD) is an effective method for screening patients with sickle cell disease (SCD) at risk for first stroke. Its usefulness in monitoring children with SCD receiving transfusions has not been established. The authors studied 17 children with SCD evaluated with TCDs and magnetic resonance angiograms (MRAs) while receiving transfusion therapy. Patients with normalized TCDs had normal MRAs that remained normal on transfusions. Patients with persistently abnormal TCDs had abnormal MRAs. In these children, TCD velocities decreased but rarely reverted to normal. Patients with low TCD velocities (<70 cm/s) had corresponding vasculopathy on MRA. Low velocities may be a risk factor for stroke and should be followed. Overall, there was good correlation between TCD velocity changes and MRA analysis.
