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TCD in sickle cell disease: an important and useful test
1Medical College of Georgia, 1429 Harper St., HF 1154, Augusta, GA 30912-3235, USA. rjadams@mail.mcg.edu
Insights
Transcranial Doppler (TCD) screening effectively identifies children with sickle cell disease (SCD) at high risk for stroke. Early detection and intervention with blood transfusions significantly reduce stroke incidence in these young patients.
Area of Science:
- Neurology
- Pediatrics
- Hematology
Background:
- Sickle cell disease (SCD) presents a significant risk of childhood stroke.
- Secondary stroke risk is substantially reduced by chronic blood transfusions.
Purpose of the Study:
- To evaluate the efficacy of transcranial Doppler (TCD) ultrasound in primary stroke prevention for children with SCD.
- To establish TCD as a screening tool for identifying high-risk individuals.
Main Methods:
- The Stroke Prevention Trial in Sickle Cell Anemia (STOP) randomized children with SCD.
- Transcranial Doppler (TCD) ultrasound assessed blood flow velocities in cerebral arteries (MCA, ICA).
- Velocity readings classified TCD results as normal, conditional, abnormal, or inadequate to stratify stroke risk.
Main Results:
- Children with abnormal TCD results randomized to monthly blood transfusions experienced significantly fewer strokes (1 vs. 10) compared to the control group.
- Transfused patients also reported fewer medical complications.
- TCD screening is recommended starting at 24 months, repeated every 6-12 months.
Conclusions:
- Transcranial Doppler (TCD) is the current gold standard for primary stroke prevention in pediatric SCD patients.
- Transcranial Doppler imaging (TCDI) offers comparable predictive value with potentially easier application.
- While not predicting all strokes, TCD and TCDI enable timely intervention, reducing first-time strokes in high-risk children.
Abstract:
Sickle cell disease is associated with a high risk of stroke in the early years of childhood. The risk of a secondary stroke can be significantly reduced through chronic blood transfusions. Prevention of the first stroke (primary prevention) was made possible through the use of transcranial Doppler (TCD) US and demonstrated in a randomized clinical trial called the stroke prevention trial in sickle cell anemia (STOP). TCD results were classified as normal, conditional, abnormal or inadequate based on velocity readings in specific arterial segments. The MCA and ICA were carefully searched to find the highest velocity, and this was used to stratify patients as to stroke risk. Those with abnormal or high-risk TCD received either monthly blood transfusions or no transfusions, and those randomized to transfusion had a much better outcome in terms of stroke (one stroke, versus ten in the control group) and also fewer other medical problems while transfused. TCD screening is recommended for SCD patients to begin at 24 months of age and should be repeated every 6-12 months during early childhood. Transcranial Doppler imaging (TCDI) can be easier to use and learn and with a few adjustments can provide equivalent predictive power. Currently, TCD is the only recommended method for treatment selection for primary-stroke prevention. MRI and MRA can provide important information on the status of the brain and the blood vessels and, when abnormal, indicate greater risk. Although TCD cannot predict all strokes, TCD and TCDI offer an opportunity to apply an effective therapy for patients in this risk group and reduce many first-time strokes.
