Variations in the Use of Transcranial Doppler and Chronic Transfusion Therapy for Stroke Prevention in Pediatric Populations at Sickle Cell Centers.

The Stroke Prevention Trial in Sickle Cell Anemia (STOP I) demonstrated a 90% risk reduction of first stroke in high-risk pediatric patients with sickle cell disease (SCD) receiving chronic transfusion therapy (CTT) (

Based on clinical observations, participants estimated the percentage of patients with eventual worsening of TCD velocity to >200 cm/sec and the approximate number of months to reach that endpoint. Responses indicated an average of 23% and 11.3 months, respectively. Of the 25 centers, all but one indicated that patients with an abnormal TCD (>200 cm/sec) were typically placed on CTT. Four participants stated that results from the STOP trial were the basis for their decision. Fifteen centers indicated that the youngest age they would initiate CTT was 1–2 years. Only 2 directors would consider CTT in children <1 year, and 3 would not initiate CTT until age 5. Although the NHLBI guidelines suggest a hemoglobin S (Hb S) target of <30%, only 5 directors stated that this was their primary factor in determining frequency of CTT. In terms of typical CTT duration, 68% said therapy was indefinite or lifelong, 20% said <1 year, 4% said 2 years, and 4% said until age 18. Although the number of participants was limited, responses indicate there is a relatively wide variation in the application of the NHLBI recommendations for TCD use and CTT in pediatric patients with SCD. The importance of these findings should be correlated both with a more extensive sample of SCD centers and the reported incidence of stroke in the pediatric population.