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Updated: Sep 8, 2025
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Optimizing Transcranial Doppler Screening for Stroke Prevention in Young African Children With Sickle Cell Disease
Derby Tembo1,2, Peter Moons3, Taty Tshimanga4
1Department of Pediatrics, Chipata Central Hospital, Chipata, Zambia.
Insights
Transcranial Doppler (TCD) screening is feasible for young children with sickle cell disease (SCD) in Africa. Many screened children showed conditional risk for stroke, indicating early cerebral vasculopathy.
Area of Science:
- Pediatric Neurology
- Vascular Ultrasound
- Hematology
Background:
- Sickle cell disease (SCD) disproportionately affects sub-Saharan Africa, leading to significant morbidity from vasculopathy and stroke.
- Transcranial Doppler (TCD) ultrasound identifies vasculopathy severity and guides therapy to reduce stroke risk in high-risk children.
- The utility and feasibility of TCD screening in very young SCD patients remain understudied.
Purpose of the Study:
- To evaluate the feasibility and preliminary findings of Transcranial Doppler (TCD) screening in children under 24 months with sickle cell disease (SCD) in Africa.
Main Methods:
- A retrospective review of TCD examinations in children ≤24 months with SCD across six African centers was conducted.
- Flow velocity measurements classified stroke risk: <170 cm/s (low), 171-199 cm/s (conditional), and >200 cm/s (high).
Main Results:
- 115 children were screened; TCD was completed in 110 (mean age 15 ± 5 months), with a 4.3% technical failure rate due to agitation.
- 95 children (86.4%) had low-risk TCD studies, while 15 (13.6%) had conditional risk studies.
- No high-risk TCD studies were observed, and conditional risk was not associated with increased anemia.
Conclusions:
- TCD screening in young children with SCD in Africa is feasible with low failure rates.
- A significant proportion of children exhibited conditional risk, suggesting early-onset cerebral vasculopathy in this population.
- Further large-scale studies are needed to establish incidence rates and inform TCD screening guidelines for African children ≤2 years with SCD.
Background:
The greatest burden of sickle cell disease (SCD) globally occurs in sub-Saharan Africa, where significant morbidity occurs secondary to SCD-induced vasculopathy and stroke. Transcranial doppler (TCD) ultrasound grades the severity of vasculopathy, with disease modifying therapy resulting in stroke risk reduction in high-risk children. The feasibility and utility of TCD screening in young children with SCD remains understudied.
Procedure:
We performed a retrospective review of TCD examination results in children ≤24 months with SCD in one of six centers in Africa. Using the time-averaged maximum of the mean flow velocity, values <170 cm/s were considered to be low risk for stroke, 171-199 cm/s conditional risk, and >200 cm/s high risk.
Results:
A total of 115 children were screened, with five (4.3%) unable to complete the TCD due to agitation. A total of 110 children with a mean age of 15 ± 5 months were included. Low risk studies were identified in 95 (86.4%) and conditional risk in 15 (13.6%). No patient had a high risk study. Those with conditional risk examinations were not more anemic than those with low risk studies (p = 0.84).
Conclusions:
TCD screening of young children with SCD is feasible, with low technical failure rates. Many children in our cohort had a conditional risk study, suggesting cerebral vasculopathy begins at a young age in some African children. Future large cohort studies should be undertaken to determine the incidence of conditional or high risk studies in African children ≤2 years with SCD to inform future guideline development for TCD screening.
