Follow-up of children with sickle cell anemia screened with transcranial Doppler and enrolled in a primary prevention program of ischemic stroke
Hematol., Transfus. Cell Ther. (Impr.)
;
44(4): 478-484, Oct.-dec. 2022. tab, ilus
Artículo
en Inglés
| LILACS
| ID: biblio-1421534
ABSTRACT
ABSTRACT Background:
Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018.Method:
This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sβ0-thalassemia who underwent TCD at least once.Results:
Of the 718 children screened during this period, 675 had HbSS and 43 Sβ0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a highrisk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke.Conclusions:
The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Accidente Cerebrovascular Isquémico
/
Anemia de Células Falciformes
Tipo de estudio:
Estudio observacional
/
Factores de riesgo
Límite:
Niño
/
Child, preschool
/
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Hematol., Transfus. Cell Ther. (Impr.)
Asunto de la revista:
Hematologia
/
TransfusÆo de Sangue
Año:
2022
Tipo del documento:
Artículo
País de afiliación:
Brasil
Institución/País de afiliación:
Fundação Hemominas/BR
/
Universidade Federal de Minas Gerais - UFMG/BR
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