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Updated: Mar 12, 2026
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Transcranial Doppler Changes in Children With Sickle Cell Disease on Transfusion Therapy
Caterina P Minniti1, Vinod K Gidvani, Dorothy Bulas
1From the *Division of Hematology/Oncology, Children's National Medical Center, Washington, DC; †Department of Pediatrics, George Washington University School of Medicine, Washington, DC; ‡Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; §Division of Radiology, Children's National Medical Center, Washington, DC; and ¶Department of Radiology, George Washington University School of Medicine, Washington, DC.
Insights
Transcranial Doppler (TCD) effectively monitors sickle cell disease (SCD) patients during transfusions. Abnormal TCD velocities correlate with magnetic resonance angiogram findings, indicating ongoing vasculopathy and potential stroke risk in children with SCD.
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 stroke risk screening in SCD.
- The utility of TCD for monitoring children with SCD undergoing transfusion therapy remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of Transcranial Doppler (TCD) in monitoring children with sickle cell disease (SCD) during transfusion therapy.
- To assess the correlation between TCD findings and magnetic resonance angiogram (MRA) results in this patient population.
Main Methods:
- A study involving 17 children with SCD undergoing transfusion therapy.
- Simultaneous evaluation using Transcranial Doppler (TCD) and magnetic resonance angiograms (MRAs).
- Analysis of TCD velocity changes and MRA findings in relation to transfusion status.
Main Results:
- Children with normalized TCD velocities showed normal and stable MRA results during transfusions.
- Persistently abnormal TCD velocities correlated with abnormal MRA findings, indicating ongoing vasculopathy.
- While TCD velocities decreased with transfusions, they rarely normalized in patients with abnormal findings. Low velocities (<70 cm/s) on TCD corresponded to MRA-detected vasculopathy.
Conclusions:
- Transcranial Doppler (TCD) demonstrates good correlation with MRA in monitoring children with SCD receiving transfusions.
- Persistently abnormal TCD velocities in SCD patients on transfusion therapy suggest ongoing vasculopathy and potential stroke risk.
- Low TCD velocities (<70 cm/s) in this context warrant close follow-up due to their association with vasculopathy.
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.
