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Transcranial Doppler in children with sickle cell disease: Five years of screening experience
1The Children's Hospital at Westmead Cnr Hawkesbury Rd Hainsworth St Westmead New South Wales 2145 Australia.
Insights
Sickle cell disease (SCD) screening using Transcranial Doppler (TCD) accurately identifies children at risk of stroke. This proactive approach has successfully prevented strokes in children within the program.
Area of Science:
- Hematology
- Pediatric Neurology
- Medical Imaging
Background:
- Sickle cell disease (SCD) is an inherited blood disorder increasing stroke risk in children.
- Stroke is a major cause of death and disability in pediatric SCD patients.
- Transcranial Doppler (TCD) can predict stroke risk in children with SCD.
Purpose of the Study:
- To evaluate the effectiveness of a TCD screening program in identifying children at risk for stroke.
- To assess the impact of TCD screening on stroke incidence in pediatric SCD patients.
Main Methods:
- Annual TCD screening using a non-imaging Doppler machine for 88 SCD patients.
- Repeat scans for reproducible assessment of abnormal velocities.
- Monitoring and potential prophylactic treatment for identified high-risk patients.
Main Results:
- No strokes occurred in any screened children during the 5-year program.
- Seven out of 88 patients exhibited high velocities, indicating elevated stroke risk.
- The TCD program successfully identified at-risk children for closer monitoring.
Conclusions:
- Implementation of a TCD program effectively identifies children with SCD at risk of stroke.
- TCD screening facilitates timely intervention and prophylactic treatment, reducing stroke incidence.
- TCD screening is a valuable tool for stroke prevention in pediatric SCD.
Introduction:
Sickle cell disease (SCD) is an autosomal recessive, inherited disorder of haemoglobin. Children with sickle cell disease (SCD) are at risk of vascular occlusions. If this occurs in the brain, it can result in stroke. Stroke is the leading cause of death and disability in children with SCD.Transcranial Doppler (TCD) has been shown to accurately predict those children at risk of stroke so appropriate preventative treatment can commence.
Method:
TCD screening with a non-imaging Doppler machine to assess stroke risk has been in operation at our institution for 5 years. Eighty-eight patients attending the haematology clinic for SCD are scanned annually. If abnormal velocities are found, repeat scans are performed at close interval to ensure results are reproducible.
Results:
No child has had a stroke since the start of our screening. Seven of the eighty-eight patients have shown high velocities on annual screening.
Conclusion:
The introduction of a TCD programme at out institution has identified children at risk of stroke so they can be closely monitored and potentially receive prophylactic treatment.
